MEDICARE: TELISHA ORTIZ M.D.

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	208600000X	Surgery Physician	MD456019	PA
2	208D00000X	General Practice Physician	MD456019	PA
3	207Q00000X	Family Medicine Physician	MD456019	PA

General Provider Information

NPI Number	:	1306257001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TELISHA ORTIZ M.D.

Provider Business Mailing Address
First Line	:	3601 SW 160TH AVE STE 250
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-6314
Country	:	US
Telephone Number	:	954-399-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 SENTRY PKWY E BLDG 5W
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-2312
Country	:	US
Telephone Number	:	954-399-4673
Fax Number	:

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	01/30/2025

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