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General NPI Number Information
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NPI Number | 1528156205
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Entity Type | Individual
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Provider Name | MS. MARY P ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5500 TESORO PLZ
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City | LAREDO
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State | TX
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Zip | 78041-5751
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Country | US
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Telephone | 956-712-8433
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Fax | 956-712-2290
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Provider Business Mailing Address
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Address Line | PO BOX 440786
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City | LAREDO
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State | TX
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Zip | 78044-0786
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Country | US
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Telephone | 956-712-8433
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Fax | 956-712-2290
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 005304
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License Number State | TX
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