Provider Demographics
NPI:1790424646
Name:ORTIZ, JOSE B
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:B
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 1:837 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4110
Mailing Address - Country:US
Mailing Address - Phone:323-755-9555
Mailing Address - Fax:323-755-9545
Practice Address - Street 1:837 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4110
Practice Address - Country:US
Practice Address - Phone:323-755-9555
Practice Address - Fax:323-755-9545
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288711164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse