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General NPI Number Information
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NPI Number | 1063848604
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Entity Type | Individual
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Provider Name | ROBERT O ORTIZ JR. MSC, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/15/2013
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 400 E VAN BUREN ST SUITE 300
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City | PHOENIX
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State | AZ
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Zip | 85004-2223
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Country | US
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Telephone | 602-258-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E MILLER CT P.O. BOX #2048
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City | CASTLE ROCK
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State | CO
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Zip | 80104-8436
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0001110
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License Number State | CO
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