Provider Demographics
NPI:1093312233
Name:ORTIZ, MARIA D (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
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 1:984 ORANGE CT
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1605
Mailing Address - Country:US
Mailing Address - Phone:559-359-9985
Mailing Address - Fax:
Practice Address - Street 1:4361 LATHAM ST STE 270
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4332
Practice Address - Country:US
Practice Address - Phone:303-876-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPS95014308207R00000X
CANPF95014308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty