MEDICARE: DR. YAMILLIE S ORTIZ LOPEZ M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	15274	PR
2	261QH0100X	Health Service Clinic/Center	15274	PR
3	208D00000X	General Practice Physician	ACN698	FL

General Provider Information

NPI Number	:	1346274982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAMILLIE S ORTIZ LOPEZ M. D.

Provider Business Mailing Address
First Line	:	6150 METROWEST BLVD STE 103
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	407-395-2348
Fax Number	:	407-395-2349

Provider Business Practice Location Address
First Line	:	6150 METROWEST BLVD STE 103
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	407-395-2348
Fax Number	:	407-395-2349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/19/2024

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