Provider Demographics
NPI:1306559273
Name:ORTIZ, ANGEL LUIS (RN CCM)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:LUIS
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 BROOKPARK RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-6809
Mailing Address - Country:US
Mailing Address - Phone:216-400-3356
Mailing Address - Fax:
Practice Address - Street 1:8787 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-6809
Practice Address - Country:US
Practice Address - Phone:216-400-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.321193163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management