Provider Demographics
NPI:1992719892
Name:ALEJANDRO ORTIZ BURGOS MD PA
Entity type:Organization
Organization Name:ALEJANDRO ORTIZ BURGOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ BURGOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-595-4136
Mailing Address - Street 1:7150 W 20TH AVE
Mailing Address - Street 2:SUITE 603
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5529
Mailing Address - Country:US
Mailing Address - Phone:305-595-4136
Mailing Address - Fax:305-596-0668
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE 603
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-595-4136
Practice Address - Fax:305-596-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074952174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF86562Medicare UPIN
FLE0317AMedicare ID - Type Unspecified