Provider Demographics
NPI:1073945374
Name:ORTIZ, ORLANDO (SFIDC)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 HALSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-5926
Mailing Address - Country:US
Mailing Address - Phone:850-449-9713
Mailing Address - Fax:
Practice Address - Street 1:534 HALSTEAD DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-5926
Practice Address - Country:US
Practice Address - Phone:850-449-9713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman