Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 21376 | TX |
NPI | 1457447021 |
---|---|
Provider Name | Dr. Carla I Ortiz |
First Address | San Antonio, TX 78205 |
Second Address | San Antonio, TX 78224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/07/2007 |