Provider Demographics
NPI:1134842792
Name:ORTIZ DIAZ, MICELYS A
Entity type:Individual
Prefix:
First Name:MICELYS
Middle Name:A
Last Name:ORTIZ DIAZ
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 1:226 MOUNT HOPE PL APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5462
Mailing Address - Country:US
Mailing Address - Phone:787-672-5283
Mailing Address - Fax:
Practice Address - Street 1:226 MOUNT HOPE PL APT 5C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5462
Practice Address - Country:US
Practice Address - Phone:787-672-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse