Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PTA28080 | FL |
NPI | 1043726201 |
---|---|
Provider Name | Maurice Ortiz |
First Address | Miami, FL 33165-4132 |
Second Address | Hialeah, FL 33012-2949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2017 |
Last Update Date | 22/12/2017 |