MEDICARE: CARLA F ORTIQUE 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	207V00000X	Obstetrics & Gynecology Physician	J7617	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700840105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA F ORTIQUE MD

Provider Business Mailing Address
First Line	:	6620 MAIN ST SUITE H1300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2331
Country	:	US
Telephone Number	:	713-797-1144
Fax Number	:	832-825-7775

Provider Business Practice Location Address
First Line	:	6620 MAIN ST SUITE H1300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2331
Country	:	US
Telephone Number	:	713-797-1144
Fax Number	:	832-825-7775

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	08/06/2024

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Directions to “ CARLA F ORTIQUE MD” Practice Location

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