Provider Demographics
NPI:1710100607
Name:ORTIZ, JOSE ANTONIO (ND)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 E BETHANY HOME RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2003
Mailing Address - Country:US
Mailing Address - Phone:602-443-2288
Mailing Address - Fax:866-475-7514
Practice Address - Street 1:1480 E BETHANY HOME RD
Practice Address - Street 2:SUITE 230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2003
Practice Address - Country:US
Practice Address - Phone:602-443-2288
Practice Address - Fax:866-475-7514
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-989175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath