=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275359465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ROSA MARIA ORTIZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3250 VINELAND RD
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34746-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-397-1551
-----------------------------------------------------
Fax | 407-397-1557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3250 VINELAND RD
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34746-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-397-1551
-----------------------------------------------------
Fax | 407-397-1557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | DO7424
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------