Provider Demographics
NPI:1346569696
Name:PILLICH ORTIZ, WALESKA (CRNA)
Entity type:Individual
Prefix:
First Name:WALESKA
Middle Name:
Last Name:PILLICH ORTIZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 BELLAROSA CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1468
Mailing Address - Country:US
Mailing Address - Phone:551-291-2703
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 AA#20 ALMIRA
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PR
Practice Address - Zip Code:00949-4007
Practice Address - Country:US
Practice Address - Phone:787-923-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9309002367500000X
PR1539367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered