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General NPI Number Information
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NPI Number | 1295111672
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Entity Type | Individual
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Provider Name | LAURA DIAZ DE ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 10125 W COLONIAL DR STE 205
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City | OCOEE
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State | FL
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Zip | 34761-4200
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Country | US
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Telephone | 407-578-1241
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Fax | 407-578-1242
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Provider Business Mailing Address
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Address Line | 10125 W COLONIAL DR STE 205
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City | OCOEE
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State | FL
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Zip | 34761-4200
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Country | US
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Telephone | 407-578-1241
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Fax | 407-578-1242
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME147279
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License Number State | FL
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