Provider Demographics
NPI:1881217297
Name:ORTIZ, LATINYA M (CNA)
Entity Type:Individual
Prefix:MS
First Name:LATINYA
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4326
Mailing Address - Country:US
Mailing Address - Phone:803-306-5752
Mailing Address - Fax:803-617-7460
Practice Address - Street 1:220 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4326
Practice Address - Country:US
Practice Address - Phone:803-306-5752
Practice Address - Fax:803-617-7460
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IHCP-1159253Z00000X
374U00000X
SCIHCP-1159251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide