Healthcare Provider Details

I. General information

NPI: 1063848604
Provider Name (Legal Business Name): ROBERT O ORTIZ JR. MSC, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2013
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6658 W SUNSET RD STE 170
LAS VEGAS NV
89118-3297
US

IV. Provider business mailing address

300 E MILLER CT P.O. BOX #2048
CASTLE ROCK CO
80104-8436
US

V. Phone/Fax

Practice location:
  • Phone: 702-558-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0001110
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0506580
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003301
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: