=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518155852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOS A ORTIZ C.S.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 08/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 ALTON RD
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-674-2720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8575 NW 193 LN
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-5321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-566-2174
-----------------------------------------------------
Fax | 305-816-0021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZS0410X
-----------------------------------------------------
Taxonomy Name | Surgical Technologist
-----------------------------------------------------
License Number | 07-238
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------