Provider Demographics
NPI:1285144147
Name:ORTIZ, CHRISTAN ROCHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTAN
Middle Name:ROCHELLE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16066 N PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7461
Mailing Address - Country:US
Mailing Address - Phone:623-523-8690
Mailing Address - Fax:623-523-8661
Practice Address - Street 1:16066 N PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7461
Practice Address - Country:US
Practice Address - Phone:623-523-8690
Practice Address - Fax:623-523-8661
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP053904164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse