Individual
MYLISSA ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
105 VICTORY RD, BOSTON, MA 02122-3518
(617) 619-6928
Mailing address
105 VICTORY RD, BOSTON, MA 02122-3518
(617) 619-6928
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2306389
MA
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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