Provider Demographics
NPI:1821150616
Name:ORTIZ, JUAN F (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:F
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 FONTAINEBLEAU BLVD
Mailing Address - Street 2:APARTM 303
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172
Mailing Address - Country:US
Mailing Address - Phone:305-559-3925
Mailing Address - Fax:
Practice Address - Street 1:1250 SW 27TH AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-642-2300
Practice Address - Fax:305-642-2300
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00262522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058698600Medicaid
FL92255Medicare ID - Type Unspecified
FL058698600Medicaid