Provider Demographics
NPI:1073887774
Name:JUAN F. ORTIZ M.D. P.A
Entity Type:Organization
Organization Name:JUAN F. ORTIZ M.D. P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-2300
Mailing Address - Street 1:1250 S.W 27TH AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4749
Mailing Address - Country:US
Mailing Address - Phone:305-642-2300
Mailing Address - Fax:305-642-2300
Practice Address - Street 1:1250 S.W. 27TH AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4749
Practice Address - Country:US
Practice Address - Phone:305-642-2300
Practice Address - Fax:305-642-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00262522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058698600Medicaid
FL058698600Medicaid