Provider Demographics
NPI:1174113021
Name:ORTEGA, EMILY (MCMSC, PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MCMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 SW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4227
Mailing Address - Country:US
Mailing Address - Phone:305-335-3385
Mailing Address - Fax:
Practice Address - Street 1:2845 AVENTURA BLVD STE 245
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3120
Practice Address - Country:US
Practice Address - Phone:305-692-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FLPA9114149363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant