Provider Demographics
NPI:1932567278
Name:ORTIZ-LUIS, SHIRLEY
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:
Last Name:ORTIZ-LUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 BAGHDADY ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8264
Mailing Address - Country:US
Mailing Address - Phone:323-445-7204
Mailing Address - Fax:
Practice Address - Street 1:880 BAGHDADY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-8264
Practice Address - Country:US
Practice Address - Phone:323-445-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist