Provider Demographics
NPI:1457074429
Name:ORTIZ, JOSE GABRIEL (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:GABRIEL
Last Name: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 1:23000 WOOD VIOLET CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-2831
Mailing Address - Country:US
Mailing Address - Phone:787-346-1514
Mailing Address - Fax:
Practice Address - Street 1:23000 WOOD VIOLET CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2831
Practice Address - Country:US
Practice Address - Phone:787-346-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor