Healthcare Provider Details

I. General information

NPI: 1326740721
Provider Name (Legal Business Name): CARLOS JOSE CORREA ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 SUNSET STRIP
SUNRISE FL
33313-6106
US

IV. Provider business mailing address

11750 BIRD RD
MIAMI FL
33175-3530
US

V. Phone/Fax

Practice location:
  • Phone: 954-225-4454
  • Fax:
Mailing address:
  • Phone: 305-485-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME171280
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME171280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: