Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2011-00555 | NC |
NPI | 1225100308 |
---|---|
Provider Name | Juan Antonio Ortiz |
First Address | Raleigh, NC 27615-2493 |
Second Address | Raleigh, NC 27615-2493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 28/02/2017 |