Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 25271 | TX |
N | 1223D0001X | Dental Public Health | DN18510 | FL |
Y | 1223G0001X | General Practice | 25271 | TX |
Y | 213EG0000X | General Practice | 25271 | TX |
NPI | 1063666907 |
---|---|
Provider Name | Melba L Ortiz-Rivera |
First Address | Monticello, FL 32344-1128 |
Second Address | Brownsville, TX 78526-3831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2008 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210080206 | (05) | TX |