Healthcare Provider Details

I. General information

NPI: 1720615149
Provider Name (Legal Business Name): RICARDO ORTIZ AMADOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR STE 400
BEVERLY HILLS CA
90210-4218
US

IV. Provider business mailing address

450 N ROXBURY DR STE 400
BEVERLY HILLS CA
90210-4218
US

V. Phone/Fax

Practice location:
  • Phone: 310-272-5310
  • Fax:
Mailing address:
  • Phone: 310-272-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA208861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: