Provider Demographics
NPI:1841301140
Name:ORTIZ-CANTILLO, KATHIA A (MD,)
Entity type:Individual
Prefix:
First Name:KATHIA
Middle Name:A
Last Name:ORTIZ-CANTILLO
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 1:2333 YARD ARM WAY
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-6001
Mailing Address - Country:US
Mailing Address - Phone:210-422-4537
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:4700 WATERS AVE STE 507
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-4750
Practice Address - Fax:912-350-4751
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108607207RC0200X, 207RP1001X, 207RS0012X
FLME137299207RP1001X, 207RS0012X, 207RC0200X
TXN1036207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202074501Medicaid
TXP00709676OtherRAIL ROAD MEDICARE
TX8F10283OtherMEDICARE
TX8BX717OtherBCBS
ILP00977005OtherMEDICARE RAIL ROAD
IL036108607Medicaid
TX8F10283OtherMEDICARE
TX8BX717OtherBCBS