Individual
LAUREN P ORTEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12221 MERIT DR, SUITE 1610, DALLAS, TX 75251-2202
(214) 217-1911
(214) 217-1912
Mailing address
12221 MERIT DR, SUITE 1610, DALLAS, TX 75251-2202
(214) 217-1911
(214) 217-1912
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A93694
CA
208000000X
Pediatrics Physician
Primary
M9558
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193652802
—
TX
01
—
8AL416
BCBS
TX
Enumeration date
05/16/2007
Last updated
01/15/2009
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