Healthcare Provider Details

I. General information

NPI: 1558907691
Provider Name (Legal Business Name): LIZ MARIE ORTIZ LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S SEMORAN BLVD
ORLANDO FL
32807-2919
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-587-7552
  • Fax: 833-450-5422
Mailing address:
  • Phone: 321-332-6947
  • Fax: 689-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21598
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: