Provider Demographics
NPI:1558196527
Name:ORTEGA, ALEJANDRO JR
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:ORTEGA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:ORTEGA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28873 COMMERCE WAY STE B4
Mailing Address - Street 2:
Mailing Address - City:WELLTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85356-7060
Mailing Address - Country:US
Mailing Address - Phone:928-785-4977
Mailing Address - Fax:
Practice Address - Street 1:28873 COMMERCE WAY STE B4
Practice Address - Street 2:
Practice Address - City:WELLTON
Practice Address - State:AZ
Practice Address - Zip Code:85356-7060
Practice Address - Country:US
Practice Address - Phone:928-785-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ014183225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant