Provider Demographics
NPI:1417649252
Name:ORTIZ, IRIS (OWNER)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DORRANCE STREET
Mailing Address - Street 2:SUITE 700 - #4600
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-865-0033
Mailing Address - Fax:
Practice Address - Street 1:10 DORRANCE STREET
Practice Address - Street 2:SUITE 700 - #4600
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-865-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIH19-7232343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)