Healthcare Provider Details

I. General information

NPI: 1841301140
Provider Name (Legal Business Name): KATHIA A. ORTIZ-CANTILLO M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S 14TH ST STE A
FERNANDINA BEACH FL
32034-3092
US

IV. Provider business mailing address

2333 YARD ARM WAY
FERNANDINA BEACH FL
32034-6001
US

V. Phone/Fax

Practice location:
  • Phone: 904-304-9068
  • Fax: 904-263-5377
Mailing address:
  • Phone: 210-422-4537
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036108607
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036108607
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberN1036
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME137299
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036108607
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME137299
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME137299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: