Provider Demographics
NPI:1790531192
Name:ORTEGON, JESUS ROBERTO JR
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ROBERTO
Last Name:ORTEGON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13455 PURDUE VLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2336
Mailing Address - Country:US
Mailing Address - Phone:830-694-9408
Mailing Address - Fax:
Practice Address - Street 1:13455 PURDUE VLY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2336
Practice Address - Country:US
Practice Address - Phone:830-694-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1366562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist