Healthcare Provider Details

I. General information

NPI: 1326048208
Provider Name (Legal Business Name): ROBERTO ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 E COLONIAL DR
ORLANDO FL
32803-5230
US

IV. Provider business mailing address

3901 E COLONIAL DR
ORLANDO FL
32803-5230
US

V. Phone/Fax

Practice location:
  • Phone: 407-203-5984
  • Fax: 877-325-2741
Mailing address:
  • Phone: 407-203-5984
  • Fax: 877-325-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME86282
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME86282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: