Provider Demographics
NPI:1518794635
Name:ORTEGA SANDOVAL, GUILLERMO OMAR (SA-C)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:OMAR
Last Name:ORTEGA SANDOVAL
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BOB HOPE DR APT 501
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1629
Mailing Address - Country:US
Mailing Address - Phone:915-335-3514
Mailing Address - Fax:
Practice Address - Street 1:1500 BOB HOPE DR APT 501
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1629
Practice Address - Country:US
Practice Address - Phone:915-335-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-452246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant