Healthcare Provider Details

I. General information

NPI: 1497495881
Provider Name (Legal Business Name): BRIANNA RAYNE ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

1111 E MCDOWELL RD # TOWER29B
PHOENIX AZ
85006-2612
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-3827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number80163
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: