Provider Demographics
NPI:1518588292
Name:GARCIA ORTIZ, SANTIAGO (MD)
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:GARCIA ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2025 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5157
Practice Address - Country:US
Practice Address - Phone:602-655-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2023-08-16
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-02-28
Provider Licenses
StateLicense IDTaxonomies
AZ68394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine