Provider Demographics
NPI:1568034676
Name:ORTIZ, ALICIA VERONICA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:VERONICA
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 1:180 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2731
Mailing Address - Country:US
Mailing Address - Phone:844-665-4827
Mailing Address - Fax:877-902-3831
Practice Address - Street 1:180 SW 84TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2731
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:877-902-3831
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date: