Provider Demographics
NPI:1609217629
Name:ORTIZ, RUBEN
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 AMY ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5367
Mailing Address - Country:US
Mailing Address - Phone:316-677-7844
Mailing Address - Fax:620-805-6127
Practice Address - Street 1:1601 E MARY ST STE 4
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3221
Practice Address - Country:US
Practice Address - Phone:620-805-6127
Practice Address - Fax:620-805-6272
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1582237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist