Provider Demographics
NPI:1821873753
Name:ORTIZ, KARLA I
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:I
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 1:3249 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4360
Mailing Address - Country:US
Mailing Address - Phone:773-371-3735
Mailing Address - Fax:773-282-6698
Practice Address - Street 1:3249 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4360
Practice Address - Country:US
Practice Address - Phone:773-371-3735
Practice Address - Fax:773-282-6698
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist