Provider Demographics
NPI:1851889935
Name:ORTIZ BAEZ, VIVIAN JOAN
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:JOAN
Last Name:ORTIZ BAEZ
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 1:9800 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4325
Mailing Address - Country:US
Mailing Address - Phone:549-475-5500
Mailing Address - Fax:954-625-8771
Practice Address - Street 1:9800 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33351-4325
Practice Address - Country:US
Practice Address - Phone:954-475-5500
Practice Address - Fax:954-625-8771
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL147575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine