Individual
MR. SANTOS EFRAIN ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4761 PAULINE RD, DOUGLASVILLE, GA 30135-4575
(678) 531-0618
Mailing address
4761 PAULINE RD, DOUGLASVILLE, GA 30135-4575
(678) 531-0618
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
45-4325039
GA
3416L0300X
Land Ambulance
45-4325039
GA
343900000X
Non-emergency Medical Transport (VAN)
Primary
45-4325039
GA
Other
Enumeration date
03/09/2012
Last updated
03/09/2012
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