MEDICARE: CAROLYN L ORTIZ PA

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	363A00000X	Physician Assistant	PA 14736	CA

General Provider Information

NPI Number	:	1679619514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN L ORTIZ PA

Provider Business Mailing Address
First Line	:	26 WILDERNESS PL
Second Line	:
City	:	PHILLIPS RANCH
State	:	CA
Zip	:	91766-6712
Country	:	US
Telephone Number	:	626-350-5073
Fax Number	:	626-350-5801

Provider Business Practice Location Address
First Line	:	4200 PECK RD
Second Line	:	SUITE #B
City	:	EL MONTE
State	:	CA
Zip	:	91732-2177
Country	:	US
Telephone Number	:	626-350-5073
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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Directions to “ CAROLYN L ORTIZ PA” Practice Location

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