Provider Demographics
NPI:1003365768
Name:ORTIZ, GILBERT R
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:R
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9552 PRADERA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2112
Mailing Address - Country:US
Mailing Address - Phone:714-932-1034
Mailing Address - Fax:
Practice Address - Street 1:9552 PRADERA AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2112
Practice Address - Country:US
Practice Address - Phone:714-932-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies