Healthcare Provider Details

I. General information

NPI: 1992719892
Provider Name (Legal Business Name): ALEJANDRO ORTIZ BURGOS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE SUITE 603
HIALEAH FL
33016-5529
US

IV. Provider business mailing address

7150 W 20TH AVE SUITE 603
HIALEAH FL
33016-5529
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-4136
  • Fax: 305-596-0668
Mailing address:
  • Phone: 305-595-4136
  • Fax: 305-596-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0074952
License Number StateFL

VIII. Authorized Official

Name: ALEJANDRO ORTIZ BURGOS JR.
Title or Position: PRESIDENT
Credential: MD PA
Phone: 305-595-4136