Provider Demographics
NPI:1902093446
Name:ORTEGA, KRISTEEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEEN
Middle Name:R
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1565 SAXON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5876
Mailing Address - Country:US
Mailing Address - Phone:386-742-4343
Mailing Address - Fax:386-742-1313
Practice Address - Street 1:1565 SAXON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5876
Practice Address - Country:US
Practice Address - Phone:386-742-4343
Practice Address - Fax:386-742-1313
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116819208VP0014X, 208VP0000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHL453ZMedicare PIN
FLHL453YMedicare PIN