Provider Demographics
NPI:1982387452
Name:ORTIZ RODRIGUEZ, ALYSSA MILENNA (RDA)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:MILENNA
Last Name:ORTIZ RODRIGUEZ
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11944 MESQUITE BUSH DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3319
Mailing Address - Country:US
Mailing Address - Phone:915-701-5307
Mailing Address - Fax:
Practice Address - Street 1:7480 REMCON CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3508
Practice Address - Country:US
Practice Address - Phone:915-259-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133031126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant