Provider Demographics
NPI:1477749968
Name:ORTIZ ORTIZ, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:ORTIZ ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:M
Other - Last Name:ORTIZ ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:410 CELEBRATION PL STE 302
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5435
Mailing Address - Country:US
Mailing Address - Phone:407-303-3824
Mailing Address - Fax:407-303-3825
Practice Address - Street 1:410 CELEBRATION PL STE 302
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5435
Practice Address - Country:US
Practice Address - Phone:407-303-3824
Practice Address - Fax:407-303-3825
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17847208600000X
FLME111860208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery