Provider Demographics
NPI:1093245771
Name:ORTIZ, LETICIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8001
Mailing Address - Country:US
Mailing Address - Phone:830-768-9200
Mailing Address - Fax:830-768-3534
Practice Address - Street 1:1801 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8001
Practice Address - Country:US
Practice Address - Phone:830-768-9200
Practice Address - Fax:830-768-3534
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132334363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner