Healthcare Provider Details

I. General information

NPI: 1922322783
Provider Name (Legal Business Name): RODOLFO ANDRES ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 6TH ST
LOS ANGELES CA
90017-1000
US

IV. Provider business mailing address

5915 MALABAR ST APT 21
HUNTINGTON PARK CA
90255-7151
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-5151
  • Fax:
Mailing address:
  • Phone: 323-715-7399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: