Provider Demographics
NPI:1790807907
Name:ORTIZ, ERNESTO (LMT)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:ERNESTO
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:9199 SW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1939
Mailing Address - Country:US
Mailing Address - Phone:305-595-1668
Mailing Address - Fax:
Practice Address - Street 1:9199 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1939
Practice Address - Country:US
Practice Address - Phone:305-595-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA12776172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist