Provider Demographics
NPI:1609322130
Name:ORTIZ ROLON, GLORIA I
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:I
Last Name:ORTIZ ROLON
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 1:1593 GLADEWATER RD
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6471
Mailing Address - Country:US
Mailing Address - Phone:321-900-5786
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST STE 273
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4673
Practice Address - Country:US
Practice Address - Phone:407-343-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator