Provider Demographics
NPI:1780611509
Name:ORTIZ, OFELIA G (MD)
Entity type:Individual
Prefix:DR
First Name:OFELIA
Middle Name:G
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-1257
Mailing Address - Country:US
Mailing Address - Phone:209-394-7913
Mailing Address - Fax:209-394-9093
Practice Address - Street 1:1140 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334
Practice Address - Country:US
Practice Address - Phone:209-394-7913
Practice Address - Fax:209-394-9093
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220255207VG0400X
NJMA07780900207VG0400X
NJ25MA07780900174400000X
CAC142634207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02150874Medicaid
NJ0067369Medicaid
NJ084937CX9Medicare PIN
NYH37815Medicare UPIN
NY466D41Medicare ID - Type UnspecifiedBLUE CROSS
NJ0067369Medicaid