Healthcare Provider Details

I. General information

NPI: 1033877766
Provider Name (Legal Business Name): MICHAEL LUIS ORTUNO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 ALOMA AVE
WINTER PARK FL
32792-9101
US

IV. Provider business mailing address

7403 ALOMA AVE
WINTER PARK FL
32792-9101
US

V. Phone/Fax

Practice location:
  • Phone: 407-677-8589
  • Fax:
Mailing address:
  • Phone: 407-677-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: