MEDICARE: LUIS ORTIZ-MUNOZ MD 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	207RC0000X	Cardiovascular Disease Physician	ME 115082	FL

General Provider Information

NPI Number	:	1760878516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUIS ORTIZ-MUNOZ MD PA

Provider Business Mailing Address
First Line	:	4685 PONCE DE LEON BLVD
Second Line	:	PO BOX 565008
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2108
Country	:	US
Telephone Number	:	305-661-2534
Fax Number	:	305-667-2115

Provider Business Practice Location Address
First Line	:	4685 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2108
Country	:	US
Telephone Number	:	305-661-2534
Fax Number	:	305-667-2115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS ORTIZ-MUNOZ
Credential	:	M.D.
Telephone Number	:	305-661-2534

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	04/21/2015

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