Individual
KIMBERLY NICOLE ORTIZ DE SOUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(800) 836-7536
Mailing address
3500 N BROAD ST, PHILADELPHIA, PA 19140-4106
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MT231711
PA
Other
Enumeration date
06/13/2024
Last updated
06/19/2024
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