Provider Demographics
NPI:1346274982
Name:ORTIZ LOPEZ, YAMILLIE S (M D)
Entity Type:Individual
Prefix:DR
First Name:YAMILLIE
Middle Name:S
Last Name:ORTIZ LOPEZ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 METROWEST BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3290
Mailing Address - Country:US
Mailing Address - Phone:407-395-2348
Mailing Address - Fax:407-395-2349
Practice Address - Street 1:6150 METROWEST BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3290
Practice Address - Country:US
Practice Address - Phone:407-395-2348
Practice Address - Fax:407-395-2349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15274208D00000X, 261QH0100X
FLACN698208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-42683Medicare UPIN