Healthcare Provider Details

I. General information

NPI: 1376407999
Provider Name (Legal Business Name): GUADALUPE ORTIZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUPITA ORTIZ RN

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 ROYAL AVE
MEDFORD OR
97504-6193
US

IV. Provider business mailing address

695 HERMAN AVE
MEDFORD OR
97501-1124
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-7460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201906201RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: