Individual
REBECCA ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
735 DON PASQUAL RD NW, LOS LUNAS, NM 87031-8493
(505) 865-3350
(505) 865-4739
Mailing address
PO BOX 518, LOS LUNAS, NM 87031-0518
(505) 865-3350
(505) 865-4739
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85-0294695
TAX ID
—
Enumeration date
08/26/2009
Last updated
08/26/2009
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