Healthcare Provider Details

I. General information

NPI: 1790569051
Provider Name (Legal Business Name): LUZ ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N 117TH AVE
OMAHA NE
68164-3629
US

IV. Provider business mailing address

6720 31ST STREET RD
GREELEY CO
80634-8926
US

V. Phone/Fax

Practice location:
  • Phone: 866-871-8519
  • Fax:
Mailing address:
  • Phone: 970-388-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number244387
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number244387
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: