Provider Demographics
NPI:1376048496
Name:ORTIZ, KENIA
Entity Type:Individual
Prefix:
First Name:KENIA
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 1:8746 SW 12TH ST APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3361
Mailing Address - Country:US
Mailing Address - Phone:786-702-6609
Mailing Address - Fax:
Practice Address - Street 1:7575 W FLAGLER ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2467
Practice Address - Country:US
Practice Address - Phone:305-377-3297
Practice Address - Fax:305-377-3854
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator