Basic Information
| Provider Information | |||||||||
| NPI: | 1780611509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | OFELIA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953341257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093947913 | ||||||||
| FaxNumber: | 2093949093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093947913 | ||||||||
| FaxNumber: | 2093949093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 220255 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VG0400X | MA07780900 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 174400000X | 25MA07780900 | NJ | N | Other Service Providers | Specialist | 207VG0400X | C142634 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 02150874 | 05 | NY | MEDICAID | 0067369 | 05 | NJ | MEDICAID |