Provider Demographics
NPI:1417193996
Name:ORTIZ, BLANCA E (MD)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:E
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:27699 JEFFERSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2661
Mailing Address - Country:US
Mailing Address - Phone:951-252-8588
Mailing Address - Fax:951-252-8589
Practice Address - Street 1:26900 NEWPORT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-9222
Practice Address - Country:US
Practice Address - Phone:951-301-5380
Practice Address - Fax:951-301-5390
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2017-05-10
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Provider Licenses
StateLicense IDTaxonomies
CAA62440208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62440OtherSTATE OF CALIFORNIA