Healthcare Provider Details

I. General information

NPI: 1447376231
Provider Name (Legal Business Name): JOSE ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W 49TH ST
HIALEAH FL
33012-3222
US

IV. Provider business mailing address

1475 W 49TH ST
HIALEAH FL
33012-3222
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-2500
  • Fax: 305-826-9002
Mailing address:
  • Phone: 305-558-2500
  • Fax: 305-826-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0078721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: