Basic Information
| Provider Information | |||||||||
| NPI: | 1518542422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ-MENDEZ | ||||||||
| FirstName: | EDGARDO | ||||||||
| MiddleName: | ONEILL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 WHITEHALL WAY | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347584114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205894867 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1502 VILLAGE OAK LN | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347466558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075203588 | ||||||||
| FaxNumber: | 4079786757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2021 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | TPME1621 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.