Healthcare Provider Details

I. General information

NPI: 1780611509
Provider Name (Legal Business Name): OFELIA G ORTIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 MAIN ST
LIVINGSTON CA
95334
US

IV. Provider business mailing address

1140 MAIN ST
LIVINGSTON CA
95334-1257
US

V. Phone/Fax

Practice location:
  • Phone: 209-394-7913
  • Fax: 209-394-9093
Mailing address:
  • Phone: 209-394-7913
  • Fax: 209-394-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number220255
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA07780900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07780900
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC142634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: