Provider Demographics
NPI:1598276255
Name:ORTIZ, MARIE A
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
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 1:4870 POOLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-7092
Mailing Address - Country:US
Mailing Address - Phone:787-461-0237
Mailing Address - Fax:
Practice Address - Street 1:4870 POOLSIDE DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-7092
Practice Address - Country:US
Practice Address - Phone:787-461-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator