Basic Information
| Provider Information | |||||||||
| NPI: | 1912488248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | LUIS | ||||||||
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| Credential: | CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6518 DOWNING ST | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784143516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618347372 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 E WARD ST | ||||||||
| Address2: | |||||||||
| City: | GOLIAD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779634006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616458902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 16595 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.