Provider Demographics
NPI:1154574853
Name:ORTIZ URDA, MARIA SUSANA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SUSANA
Last Name:ORTIZ URDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:900 BLAKE WILBUR DRIVE
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5334
Mailing Address - Country:US
Mailing Address - Phone:650-723-6316
Mailing Address - Fax:650-723-7796
Practice Address - Street 1:900 BLAKE WILBUR DRIVE
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305
Practice Address - Country:US
Practice Address - Phone:650-723-6316
Practice Address - Fax:650-723-7796
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA105136207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology