Provider Demographics
NPI:1366590101
Name:ORTIZ, JULIO R (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:R
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:STE 120
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-220-2626
Mailing Address - Fax:305-220-2082
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:STE 120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-220-2626
Practice Address - Fax:305-220-2082
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME57741207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052254600Medicaid
FL052254601Medicaid
FLE67508Medicare UPIN
FL052254600Medicaid
FL11923AMedicare PIN