Provider Demographics
NPI:1194926394
Name:ORTIZ CRUZADO, ERNESTO A (MD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:A
Last Name:ORTIZ CRUZADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-688-6490
Mailing Address - Fax:
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-688-6490
Practice Address - Fax:614-688-6491
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084827207Q00000X, 2084P0800X
CAA100436207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70042FMedicaid
OH0089298Medicaid
CAFHC 70044ZMedicaid
CAFHC 70044ZMedicaid
CAFHC70042FMedicaid
CA0A1004360Medicare PIN