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Organization
PARKSIDE MEDICAL, LLC
Active
Organization
PARKSIDE MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL ORTIZ PA-C (MEMBER)
(928) 539-0055
Entity
Organization
Contact information
Practice address
501 W 8TH ST, YUMA, AZ 85364-2956
(928) 782-9000
Mailing address
501 W 8TH ST, YUMA, AZ 85364-2956
(928) 782-9000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
12/08/2014
Last updated
12/08/2014
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