Healthcare Provider Details

I. General information

NPI: 1669185716
Provider Name (Legal Business Name): ANGEL NORBERTO ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 ISLAND WALK DR
ORLANDO FL
32824-4708
US

IV. Provider business mailing address

2058 ISLAND WALK DR
ORLANDO FL
32824-4708
US

V. Phone/Fax

Practice location:
  • Phone: 689-837-6400
  • Fax:
Mailing address:
  • Phone: 689-837-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: