Individual
MS. MARY P ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5500 TESORO PLZ, LAREDO, TX 78041-5751
(956) 712-8433
(956) 712-2290
Mailing address
PO BOX 440786, LAREDO, TX 78044-0786
(956) 712-8433
(956) 712-2290
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
005304
TX
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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