MEDICARE: EDSON 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	163WC3500X	Cardiac Rehabilitation Registered Nurse	1032896	TX
2	163WG0000X	General Practice Registered Nurse	1032896	TX
3	163WI0500X	Infusion Therapy Registered Nurse	1032896	TX
4	163WM0705X	Medical-Surgical Registered Nurse	1032896	TX

General Provider Information

NPI Number	:	1336975507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDSON ORTIZ

Provider Business Mailing Address
First Line	:	811 FLORIDA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-1849
Country	:	US
Telephone Number	:	915-433-5870
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 MERTON MINTER ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4404
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:

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

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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Directions to “ EDSON ORTIZ ” Practice Location

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