Healthcare Provider Details

I. General information

NPI: 1285615427
Provider Name (Legal Business Name): CRISANTO ORTIZ ORTIZ-LUIS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8341 JAYSEEL ST
SUNLAND CA
91040-2400
US

IV. Provider business mailing address

8341 JAYSEEL ST
SUNLAND CA
91040-2400
US

V. Phone/Fax

Practice location:
  • Phone: 818-293-1949
  • Fax:
Mailing address:
  • Phone: 818-293-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: