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General NPI Number Information
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NPI Number | 1194926394
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Entity Type | Individual
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Provider Name | ERNESTO A. ORTIZ CRUZADO MD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 543 TAYLOR AVE
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City | COLUMBUS
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State | OH
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Zip | 43203-1278
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Country | US
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Telephone | 614-688-6490
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Fax | 614-688-6491
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Provider Business Mailing Address
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Address Line | 700 ACKERMAN RD STE 2120
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City | COLUMBUS
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State | OH
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Zip | 43202-1559
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Country | US
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Telephone | 614-688-6490
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35084827
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A100436
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A100436
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35084827
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License Number State | OH
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