Healthcare Provider Details

I. General information

NPI: 1497267975
Provider Name (Legal Business Name): JULIE MARIE ORTIZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ACOSTA

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 CERRILLOS RD
SANTA FE NM
87505-3264
US

IV. Provider business mailing address

2308 CERRILLOS RD
SANTA FE NM
87505-3264
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-7874
  • Fax:
Mailing address:
  • Phone: 505-471-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022929
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008844
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: