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General NPI Number Information
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NPI Number | 1720353642
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Entity Type | Individual
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Provider Name | MR. SANTOS EFRAIN ORTIZ
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Gender | Male
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 4761 PAULINE RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-4575
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Country | US
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Telephone | 678-531-0618
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Fax |
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Provider Business Mailing Address
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Address Line | 4761 PAULINE RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-4575
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Country | US
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Telephone | 678-531-0618
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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 | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 45-4325039
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 146M00000X
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Taxonomy Name | Intermediate Emergency Medical Technician
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License Number | 45-4325039
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 45-4325039
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License Number State | GA
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