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General NPI Number Information
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NPI Number | 1720601057
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Entity Type | Organization
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Legal Business Name | ORTAVERA CORPORATION
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 13500 SW 88TH ST STE 211
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City | MIAMI
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State | FL
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Zip | 33186-1528
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Country | US
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Telephone | 786-873-7807
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Fax | 786-502-3985
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Provider Business Mailing Address
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Address Line | 14996 SW 108TH TER
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City | MIAMI
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State | FL
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Zip | 33196-2507
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Country | US
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Telephone | 786-718-5454
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Fax | 786-502-3985
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALBERTO ORTA IGLESIAS
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Credential | MD
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Telephone | 786-718-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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