Provider Demographics
NPI:1396591160
Name:ROMAN ORTIZ, EDZEL (DC)
Entity type:Individual
Prefix:
First Name:EDZEL
Middle Name:
Last Name:ROMAN ORTIZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S KIRKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2308
Mailing Address - Country:US
Mailing Address - Phone:407-802-4476
Mailing Address - Fax:
Practice Address - Street 1:2222 S KIRKMAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2308
Practice Address - Country:US
Practice Address - Phone:407-802-4476
Practice Address - Fax:407-942-3316
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor