Provider Demographics
NPI:1780385773
Name:ORTIZ GOMEZ, LUIS RAUL (DC)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAUL
Last Name:ORTIZ GOMEZ
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 1:1138 BELT LINE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-1993
Mailing Address - Country:US
Mailing Address - Phone:469-969-0427
Mailing Address - Fax:469-969-0425
Practice Address - Street 1:1138 BELT LINE RD STE 135
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-1993
Practice Address - Country:US
Practice Address - Phone:469-969-0427
Practice Address - Fax:469-969-0425
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor