MEDICARE: LOLA 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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1649578998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOLA ORTIZ

Provider Business Mailing Address
First Line	:	1113 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3334
Country	:	US
Telephone Number	:	252-337-9844
Fax Number	:	252-337-9845

Provider Business Practice Location Address
First Line	:	1113 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3334
Country	:	US
Telephone Number	:	252-337-9844
Fax Number	:	252-337-9845

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

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/10/2011

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Directions to “ LOLA ORTIZ ” Practice Location

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