Provider Demographics
NPI:1922231430
Name:TOSADO ORTIZ, THEREZA C (MD)
Entity type:Individual
Prefix:DR
First Name:THEREZA
Middle Name:C
Last Name:TOSADO ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24518 SW 13TH LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4492
Mailing Address - Country:US
Mailing Address - Phone:787-378-3084
Mailing Address - Fax:
Practice Address - Street 1:568 NE 255TH ST
Practice Address - Street 2:
Practice Address - City:CROSS CITY
Practice Address - State:FL
Practice Address - Zip Code:32628-5877
Practice Address - Country:US
Practice Address - Phone:352-498-4741
Practice Address - Fax:352-498-4337
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17726208D00000X
FLACN 384208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice