Individual
PEDRO ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 DELTONA BLVD APT 40A, DELTONA, FL 32725-6386
(386) 202-6025
Mailing address
1205 S WOODLAND BLVD STE 3, DELAND, FL 32720-7464
(386) 202-6025
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
008557
PR
363AM0700X
Medical Physician Assistant
Primary
PA9119021
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205411
REGISTRY NUMBER
—
01
—
PA9119021
MEDICAL LICENSE
FL
Enumeration date
04/19/2017
Last updated
07/24/2024
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