Provider Demographics
NPI:1285983858
Name:ORTIZ-LUIS, LOUIE CRESPO (MD)
Entity type:Individual
Prefix:
First Name:LOUIE
Middle Name:CRESPO
Last Name:ORTIZ-LUIS
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 1:35455 DUMBARTON COURT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560
Mailing Address - Country:US
Mailing Address - Phone:510-494-1724
Mailing Address - Fax:510-494-1025
Practice Address - Street 1:35455 DUMBARTON COURT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560
Practice Address - Country:US
Practice Address - Phone:510-494-1724
Practice Address - Fax:510-494-1025
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50228208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice