Healthcare Provider Details

I. General information

NPI: 1578699443
Provider Name (Legal Business Name): CARLOS WILFREDO ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST STE 102
MIAMI FL
33169-5510
US

IV. Provider business mailing address

P.O. 1197
GUAYAMA PR
00785-1197
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-5688
  • Fax:
Mailing address:
  • Phone: 787-839-4150
  • Fax: 787-839-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number08340
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: