Provider Demographics
NPI:1609823020
Name:MILDRED ORTIZ-VEGA
Entity Type:Organization
Organization Name:MILDRED ORTIZ-VEGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.,P.A.
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:305-262-7778
Mailing Address - Street 1:2921 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2826
Mailing Address - Country:US
Mailing Address - Phone:305-262-7778
Mailing Address - Fax:
Practice Address - Street 1:2921 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2826
Practice Address - Country:US
Practice Address - Phone:305-262-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6543Medicare ID - Type Unspecified