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General NPI Number Information
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NPI Number | 1922232065
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Entity Type | Individual
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Provider Name | GLORIA M REYES- ORTIZ PA
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Gender | Female
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 225 W HIGHWAY 434 SUITE 203
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City | LONGWOOD
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State | FL
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Zip | 32750-4980
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Country | US
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Telephone | 407-459-4360
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Fax | 321-316-4714
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Provider Business Mailing Address
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Address Line | 7301 STONEROCK CIR SUITE 2
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City | ORLANDO
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State | FL
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Zip | 32819-8004
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Country | US
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Telephone | 407-351-1002
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Fax | 407-351-1119
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 9104944
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License Number State | FL
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