Provider Demographics
NPI:1861797284
Name:ORTEGON, EMMA R (IMH)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:R
Last Name:ORTEGON
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16468 SW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5160
Mailing Address - Country:US
Mailing Address - Phone:305-218-9117
Mailing Address - Fax:
Practice Address - Street 1:4000 PONCE DE LEON BLVD STE 470
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1432
Practice Address - Country:US
Practice Address - Phone:305-777-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health