Healthcare Provider Details

I. General information

NPI: 1770097180
Provider Name (Legal Business Name): CHANTELL K ORTEGA-GONZALEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N LEJEUNE RD FL 4
MIAMI FL
33126-5489
US

IV. Provider business mailing address

242 N LEJEUNE RD FL 4
MIAMI FL
33126-5489
US

V. Phone/Fax

Practice location:
  • Phone: 305-267-5544
  • Fax: 305-265-1055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9320791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: