Provider Demographics
NPI:1831890995
Name:ORTIZ, JULIO (FNP)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1406
Mailing Address - Country:US
Mailing Address - Phone:760-626-5171
Mailing Address - Fax:
Practice Address - Street 1:1001 E BIRCH ST STE 1
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-5915
Practice Address - Country:US
Practice Address - Phone:760-890-5593
Practice Address - Fax:760-545-0251
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024587363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner