Healthcare Provider Details

I. General information

NPI: 1285564088
Provider Name (Legal Business Name): JULIO IVAN ORTIZ ROCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 E WILLS AVE
DOVER OH
44622-2055
US

IV. Provider business mailing address

637 E WILLS AVE
DOVER OH
44622-2055
US

V. Phone/Fax

Practice location:
  • Phone: 330-407-3069
  • Fax:
Mailing address:
  • Phone: 330-407-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberNONE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: