Provider Demographics
NPI:1932089380
Name:ORTIZ, GIANCARLOS J
Entity type:Individual
Prefix:
First Name:GIANCARLOS
Middle Name:J
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 NW SOUTH RIVER DR LOT B202
Mailing Address - Street 2:LOT 202
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7468
Mailing Address - Country:US
Mailing Address - Phone:786-560-3178
Mailing Address - Fax:
Practice Address - Street 1:5901 NW 183RD ST STE 207
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6007
Practice Address - Country:US
Practice Address - Phone:786-560-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-469082106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician