Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023635075 |
---|---|
Provider Name | Isidro Ortiz |
First Address | Huntington Park, CA 90255-3699 |
Second Address | Huntington Park, CA 90255-3699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2020 |
Last Update Date | 25/06/2020 |