Provider Demographics
NPI:1104522713
Name:ORTIZ CASTRO, PAOLA MICHELLE (DC)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:MICHELLE
Last Name:ORTIZ CASTRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 CARLISLE ST APT 431
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1162
Mailing Address - Country:US
Mailing Address - Phone:787-237-6680
Mailing Address - Fax:
Practice Address - Street 1:2909 COLE AVE STE 205
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1032
Practice Address - Country:US
Practice Address - Phone:214-979-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor