Provider Demographics
NPI:1215030499
Name:ORITI, FREDERICK MARIO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:MARIO
Last Name:ORITI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1308 PALUXY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5689
Mailing Address - Country:US
Mailing Address - Phone:817-579-3978
Mailing Address - Fax:817-579-3977
Practice Address - Street 1:1308 PALUXY RD STE 300
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5689
Practice Address - Country:US
Practice Address - Phone:817-579-3978
Practice Address - Fax:817-579-3977
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ45286Medicare UPIN