Provider Demographics
NPI:1538727359
Name:ORTEGA, ROBERT III (NEMT PROVIDER)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ORTEGA
Suffix:III
Gender:M
Credentials:NEMT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 SE 20TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2609
Mailing Address - Country:US
Mailing Address - Phone:305-582-6368
Mailing Address - Fax:904-369-9015
Practice Address - Street 1:1513 SE 20TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2609
Practice Address - Country:US
Practice Address - Phone:305-582-6368
Practice Address - Fax:904-369-9015
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJT73597146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL343900000XOtherNON-EMERGENCY MEDICAL TRANSPORTATION (VAN)