MEDICARE: GUADALUPE ORTIZ RN

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	163W00000X	Registered Nurse	201906201RN	OR

General Provider Information

NPI Number	:	1376407999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE ORTIZ RN

Provider Business Mailing Address
First Line	:	695 HERMAN AVE
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-1124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 ROYAL AVE
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6193
Country	:	US
Telephone Number	:	541-732-7460
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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