Provider Demographics
NPI:1649536426
Name:ORTIZ, AHITSHA (DC)
Entity type:Individual
Prefix:DR
First Name:AHITSHA
Middle Name:
Last Name:ORTIZ
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 1:5301 CONROY RD, SUITE 180
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-3551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5301 CONROY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3551
Practice Address - Country:US
Practice Address - Phone:407-203-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGL808ZMedicare PIN