Provider Demographics
NPI:1093038150
Name:GARCIA-ORTIZ, SANDRA M (DPM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:GARCIA-ORTIZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11435 SW 133RD CT APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7984
Mailing Address - Country:US
Mailing Address - Phone:305-528-1407
Mailing Address - Fax:786-472-8801
Practice Address - Street 1:11435 SW 133RD CT APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7984
Practice Address - Country:US
Practice Address - Phone:305-528-1407
Practice Address - Fax:786-472-8801
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3370213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO 3370Medicare UPIN