Individual
GINA C ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1691 GALISTEO ST, SUITE D, SANTA FE, NM 87505-4780
(505) 984-2300
(505) 988-1940
Mailing address
1691 GALISTEO ST, SUITE D, SANTA FE, NM 87505-4780
(505) 984-2300
(505) 988-1940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2008-0049
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
73220566
—
NM
Enumeration date
02/11/2009
Last updated
02/11/2009
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