Provider Demographics
NPI:1578636726
Name:ORTIZ, KRISTI D (PA)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:D
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:D
Other - Last Name:BRANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1222 BERWICK MANOR CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3046
Mailing Address - Country:US
Mailing Address - Phone:832-654-0453
Mailing Address - Fax:281-430-4350
Practice Address - Street 1:1222 BERWICK MANOR CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3046
Practice Address - Country:US
Practice Address - Phone:832-654-0453
Practice Address - Fax:281-430-4350
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP15410Medicare UPIN