Healthcare Provider Details

I. General information

NPI: 1437407962
Provider Name (Legal Business Name): ELVIN ORTIZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

5333 COLLINS AVE PH 5
MIAMI BEACH FL
33140-3249
US

V. Phone/Fax

Practice location:
  • Phone: 305-285-2703
  • Fax: 305-285-2903
Mailing address:
  • Phone: 787-525-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberRPT38064
License Number StateFL

VIII. Authorized Official

Name: MR. ELVIN ORTIZ
Title or Position: PHARMACY TECHNICIAN
Credential: CPHT
Phone: 787-525-2010