Provider Demographics
NPI:1811935984
Name:ORTIZ, KAREL JILL (MD)
Entity type:Individual
Prefix:DR
First Name:KAREL
Middle Name:JILL
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2220 GRANDE BLVD SE STE B
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1687
Mailing Address - Country:US
Mailing Address - Phone:505-896-2900
Mailing Address - Fax:505-938-4198
Practice Address - Street 1:2220 GRANDE BLVD SE STE B
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1687
Practice Address - Country:US
Practice Address - Phone:505-896-2900
Practice Address - Fax:505-938-4198
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0405207N00000X, 207NS0135X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77437Medicare UPIN