Provider Demographics
NPI:1184864829
Name:ORTIZ, JESUS SANCHEZ
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:SANCHEZ
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 MCDOWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026
Mailing Address - Country:US
Mailing Address - Phone:830-570-2070
Mailing Address - Fax:830-767-2067
Practice Address - Street 1:1909 MCDOWELL AVENUE
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026
Practice Address - Country:US
Practice Address - Phone:830-570-2070
Practice Address - Fax:830-767-2067
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications