Healthcare Provider Details

I. General information

NPI: 1629012224
Provider Name (Legal Business Name): ORLANDO A ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

IV. Provider business mailing address

PO BOX 95000-5560
PHILADELPHIA PA
19195-5560
US

V. Phone/Fax

Practice location:
  • Phone: 281-766-0959
  • Fax:
Mailing address:
  • Phone: 866-388-2919
  • Fax: 866-388-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number178399
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number178399
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number178399
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME161348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: