Provider Demographics
NPI:1922232065
Name:REYES- ORTIZ, GLORIA M (PA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:REYES- ORTIZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7301 STONEROCK CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8004
Mailing Address - Country:US
Mailing Address - Phone:407-351-1002
Mailing Address - Fax:407-351-1119
Practice Address - Street 1:225 W HIGHWAY 434
Practice Address - Street 2:SUITE 203
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4980
Practice Address - Country:US
Practice Address - Phone:407-459-4360
Practice Address - Fax:321-316-4714
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2015-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9104944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9104944OtherPA-C LICENSE
FLPA 9104944OtherPA-C LICENSE