Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 30-04-2012-PRO-00039 | PR |
Y | 207W00000X | Ophthalmologist | Q9221 | TX |
NPI | 1013272574 |
---|---|
Provider Name | Miss Vanessa Ortiz-Medina |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 30/08/2016 |