Provider Demographics
NPI:1740491158
Name:ORTIZ, GUSTAVO ANDRES (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ANDRES
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:251 GALEN DR
Mailing Address - Street 2:APT 311E
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2182
Mailing Address - Country:US
Mailing Address - Phone:305-873-3632
Mailing Address - Fax:305-585-1899
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-1864
Practice Address - Fax:305-585-1899
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN54592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology