Provider Demographics
NPI:1366471740
Name:ORTIZ, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9093 RIDGEFIELD DR
Mailing Address - Street 2:STE 107
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6710
Mailing Address - Country:US
Mailing Address - Phone:301-620-8566
Mailing Address - Fax:301-620-8568
Practice Address - Street 1:9093 RIDGEFIELD DR
Practice Address - Street 2:STE 107
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6710
Practice Address - Country:US
Practice Address - Phone:301-620-8566
Practice Address - Fax:301-620-8568
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor