MEDICARE: LUIS 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1124571146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ORTIZ

Provider Business Mailing Address
First Line	:	389 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3977
Country	:	US
Telephone Number	:	619-401-3770
Fax Number	:	619-401-3990

Provider Business Practice Location Address
First Line	:	389 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3977
Country	:	US
Telephone Number	:	619-401-3770
Fax Number	:	619-401-3990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	08/09/2017

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Directions to “ LUIS ORTIZ ” Practice Location

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