Healthcare Provider Details

I. General information

NPI: 1902306046
Provider Name (Legal Business Name): VANESSA MILAN ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 SURFSIDE BLVD STE 106
CAPE CORAL FL
33914-3861
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9633
  • Fax:
Mailing address:
  • Phone: 239-343-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME179914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: