Provider Demographics
NPI:1457447021
Name:ORTIZ, CARLA I
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:I
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 1:332 W COMMERCE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205
Mailing Address - Country:US
Mailing Address - Phone:210-207-8895
Mailing Address - Fax:210-207-8999
Practice Address - Street 1:9011 POTEET JOURDANTON FWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224
Practice Address - Country:US
Practice Address - Phone:210-924-9035
Practice Address - Fax:210-924-6273
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213761223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health