Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME42271 | FL |
NPI | 1083082895 |
---|---|
Provider Name | Edith Maria Ortega |
First Address | Neptune Beach, FL 32266 |
Second Address | Neptune Beach, FL 32266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2015 |
Last Update Date | 10/09/2015 |