Provider Demographics
NPI:1851951024
Name:ORTIZ RODRIGUEZ, MARIAN DENISSE
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:DENISSE
Last Name:ORTIZ RODRIGUEZ
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 1:528 PRESTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8817
Mailing Address - Country:US
Mailing Address - Phone:787-204-6112
Mailing Address - Fax:
Practice Address - Street 1:3775 VENTURE DR BLDG F
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5102
Practice Address - Country:US
Practice Address - Phone:404-592-1158
Practice Address - Fax:678-400-0021
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor