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General NPI Number Information
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NPI Number | 1285582627
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Entity Type | Individual
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Provider Name | JOSE CARLOS ORTIZ GRACIA
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Gender | Male
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 3D MARINE RAIDER BATTALION
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City | FPO
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State | AA
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Zip | 28546
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Country | US
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Telephone | 910-440-1947
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Fax |
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Provider Business Mailing Address
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Address Line | 7403 W RIVER RIM PL
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City | TUCSON
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State | AZ
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Zip | 85743-5421
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Country | US
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Telephone | 787-422-2133
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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