Provider Demographics
NPI:1023430816
Name:ORTIZ, HUMBERTO JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:HUMBERTO
Middle Name:
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:HUMBERTO
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:P.O BOX 5520
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:610-954-8040
Mailing Address - Fax:
Practice Address - Street 1:1 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018
Practice Address - Country:US
Practice Address - Phone:610-954-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100491367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered