MEDICARE: JORGE GARCIA ORTIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7022243	ZZ

General Provider Information

NPI Number	:	1114469012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORGE GARCIA ORTIZ

Provider Business Mailing Address
First Line	:	4275 EXECUTIVE SQ
Second Line	:	SUITE 200
City	:	LA JOLLA
State	:	CA
Zip	:	92037-9123
Country	:	US
Telephone Number	:	800-743-3900
Fax Number	:	866-727-6924

Provider Business Practice Location Address
First Line	:	BLVD. LAS AMERICAS 4290 1
Second Line	:	FRACC. LOMAS DE AGUA CALIENTE
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22024
Country	:	MX
Telephone Number	:	664-681-9136
Fax Number	:	866-272-6924

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JORGE GARCIA ORTIZ
Credential	:	DDS
Telephone Number	:	800-743-3900

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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