MEDICARE: MONICA ORTIZ GONZALEZ MD

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1508378407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA ORTIZ GONZALEZ MD

Provider Business Mailing Address
First Line	:	7208 TWINWOOD TRCE
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-7259
Country	:	US
Telephone Number	:	787-365-1182
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 S ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-5745
Country	:	US
Telephone Number	:	407-382-9079
Fax Number	:

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

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	10/31/2017

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