Provider Demographics
NPI:1386165793
Name:ORTIZ VARGAS, ALFONSO MANUEL (MD)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:MANUEL
Last Name:ORTIZ VARGAS
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 1:3450 NW 85TH CT APT 320
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1946
Mailing Address - Country:US
Mailing Address - Phone:212-470-8703
Mailing Address - Fax:
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 605
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2074
Practice Address - Country:US
Practice Address - Phone:453-445-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME156334207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program