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Individual
DEMETRIO ORTIZ QUISMORIO JR.
Active
Individual
DEMETRIO ORTIZ QUISMORIO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA14870
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0PA148700
—
CA
01
—
970008971
RR MEDICARE
—
Enumeration date
08/10/2006
Last updated
05/09/2011
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