Provider Demographics
NPI:1417340639
Name:ORTIZ MORALES, EDGAR (ATC)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:ORTIZ MORALES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 HEINER ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3058
Mailing Address - Country:US
Mailing Address - Phone:310-930-1761
Mailing Address - Fax:
Practice Address - Street 1:9430 HEINER ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3058
Practice Address - Country:US
Practice Address - Phone:310-930-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000017542OtherNATABOC CERTIFICATION