Basic Information
| Provider Information | |||||||||
| NPI: | 1811441827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | ANDREINA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1517 FREEMANTLE | ||||||||
| Address2: | |||||||||
| City: | CLINT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 798365206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152557742 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10501 GATEWAY BLVD W BLDG 13 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155443500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2016 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.