Provider Demographics
NPI:1881114445
Name:ORTIZ GONZALEZ, YEDIDIACH (MD)
Entity type:Individual
Prefix:
First Name:YEDIDIACH
Middle Name:
Last Name:ORTIZ GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10543 MERE PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6153
Mailing Address - Country:US
Mailing Address - Phone:787-613-6990
Mailing Address - Fax:
Practice Address - Street 1:325 CYPRESS PKWY # 34759
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3326
Practice Address - Country:US
Practice Address - Phone:407-530-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19982207P00000X, 208D00000X
390200000X
FLME164818207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program