Provider Demographics
NPI:1770001836
Name:ORTIZ BLANCO, OSCAR ANTONIO
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:ANTONIO
Last Name:ORTIZ BLANCO
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 1:28798 OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1143
Mailing Address - Country:US
Mailing Address - Phone:786-738-7426
Mailing Address - Fax:
Practice Address - Street 1:28798 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1143
Practice Address - Country:US
Practice Address - Phone:786-738-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician