Provider Demographics
NPI:1275359465
Name:ORTIZ, ROSA MARIA
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:MARIA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4893
Mailing Address - Country:US
Mailing Address - Phone:407-397-1551
Mailing Address - Fax:407-397-1557
Practice Address - Street 1:3250 VINELAND RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4893
Practice Address - Country:US
Practice Address - Phone:407-397-1551
Practice Address - Fax:407-397-1557
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7424156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician