Healthcare Provider Details

I. General information

NPI: 1497488225
Provider Name (Legal Business Name): RUBEN ORTIZ LSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8304 SHAVER DR
EL PASO TX
79925-4907
US

IV. Provider business mailing address

3906 MELCER DR STE 601
ROWLETT TX
75088-7728
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: RUBEN ORTIZ
Title or Position: OWNER
Credential: LSA
Phone: 214-227-2457