Provider Demographics
NPI:1982399572
Name:ORTIZ, GABRIELE CLARK (BA, COA)
Entity Type:Individual
Prefix:
First Name:GABRIELE
Middle Name:CLARK
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:BA, COA
Other - Prefix:
Other - First Name:GABRIELE
Other - Middle Name:MARY
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, COA
Mailing Address - Street 1:733 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4307
Mailing Address - Country:US
Mailing Address - Phone:484-493-8244
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other