Active NPI 1477650570
Individual Practitioner
Female Practitioner
Dr. Nancy D Ortiz , MD
General Practice • Orange City, FL
✓ Accepts Medicare Assignment
Professional Overview & Biography Verified Profile Summary
Dr. Nancy Ortiz, MD is a certified General Practice practicing in Orange City, FL. With approximately 27 years of clinical experience since completing medical education in 1999, Dr. Ortiz delivers high-quality medical care to the local community at 876 SAXON BLVD.
Dr. Ortiz is affiliated with Conviva Medical Center Management, Llc and accepts Medicare assignment.
Frequently performed procedures and clinical services include established patient outpatient office visit, visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's, injection, ceftriaxone sodium, per 250 mg. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.
Practice Location & Contact Primary Location
Practice Address
876 Saxon Blvd
Orange City, FL 327638214
Telephone
3866689800
Associated Practice Facility / Clinic
🏢
Deltona Medical Center Llc
Facility NPI 1376661710
Medicare Profile & Education
Medical School
Other
Graduation Year
1999
Medicare Assignment
✓ Accepts Assignment
Telehealth Flag
In-Person Only
Specialty Benchmarks & Practice Insights
Comparative analytics for General Practice in Orange City, FL
Practitioner Clinical Experience
27 Yrs
-4.1 yrs vs City Avg
City Avg: 31.1 Yrs
State Avg: 26.1 Yrs
Regional Practice Density
9
Specialists
Practicing in Orange City, FL (2490 Statewide)
Telehealth Adoption Rate
33.3%
Regional Adoption
In-Person Office Visits Only
Medicare Pricing Discount
41.9%
Avg Savings
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Clinical Seniority & Experience Comparison
Dr. Ortiz (27 Years)
27 Yrs
Orange City Specialty Average (31.1 Years)
31.1 Yrs
Performed Procedures & Service Volume
Top Medicare Part B procedures performed by this practitioner
CMS Official Data (2024)
Reporting Year:
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
123 | 47 | $206.73 | $124.27 |
|
G2211
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's
|
16 | 15 | $35.00 | $16.08 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
336 | 71 | $204.00 | $125.14 |
|
J0696
Injection, ceftriaxone sodium, per 250 mg
|
47 | 17 | $19.43 | $0.50 |
|
96372
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
|
27 | 16 | $20.26 | $13.70 |
|
J1885
Injection, ketorolac tromethamine, per 15 mg
|
23 | 11 | $43.30 | $0.57 |
|
J2930
Injection, methylprednisolone sodium succinate, up to 125 mg
|
13 | 12 | $36.00 | $5.28 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
277 | 88 | $205.07 | $126.20 |
|
86769
Measure of severe acute respiratory syndrome coronavirus 2 (covid-19) antibody
|
39 | 27 | $84.26 | $42.13 |
|
36415
Insertion of needle into vein for collection of blood sample
|
35 | 35 | $6.00 | $3.00 |
|
80053
Blood test, comprehensive group of blood chemicals
|
34 | 34 | $24.00 | $10.56 |
|
96372
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
|
34 | 24 | $20.88 | $14.01 |
|
80061
Blood test, lipids (cholesterol and triglycerides)
|
34 | 34 | $30.00 | $13.39 |
|
84443
Blood test, thyroid stimulating hormone (TSH)
|
33 | 33 | $38.00 | $16.80 |
|
85025
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
|
33 | 33 | $18.00 | $7.77 |
|
81003
Automated urinalysis test
|
29 | 29 | $6.00 | $2.25 |
|
82607
Cyanocobalamin (vitamin B-12) level
|
26 | 26 | $34.00 | $15.08 |
|
82746
Folic acid level
|
25 | 25 | $34.00 | $14.70 |
|
82043
Urine microalbumin (protein) level
|
25 | 25 | $14.00 | $5.78 |
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
24 | 17 | $144.25 | $88.76 |
|
83036
Hemoglobin A1C level
|
24 | 24 | $22.00 | $9.71 |
|
82570
Creatinine level to test for kidney function or muscle injury
|
23 | 23 | $12.00 | $5.18 |
|
84481
Thyroid hormone, t3 measurement, free
|
21 | 21 | $38.00 | $16.94 |
|
84439
Thyroxine (thyroid chemical), free
|
21 | 21 | $22.00 | $9.02 |
|
82306
Vitamin d-3 level
|
16 | 16 | $66.00 | $29.60 |
|
83540
Iron level
|
16 | 16 | $16.00 | $6.47 |
|
83550
Iron binding capacity
|
16 | 16 | $20.00 | $8.74 |
|
82728
Ferritin (blood protein) level
|
13 | 13 | $32.00 | $13.63 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
484 | 120 | $216.83 | $124.14 |
|
36415
Insertion of needle into vein for collection of blood sample
|
197 | 81 | $6.00 | $3.00 |
|
84443
Blood test, thyroid stimulating hormone (TSH)
|
186 | 80 | $38.00 | $16.80 |
|
85025
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
|
184 | 80 | $18.00 | $7.77 |
|
80053
Blood test, comprehensive group of blood chemicals
|
182 | 80 | $24.00 | $10.56 |
|
80061
Blood test, lipids (cholesterol and triglycerides)
|
179 | 78 | $30.00 | $13.39 |
|
81003
Automated urinalysis test
|
158 | 74 | $6.00 | $2.25 |
|
86769
Measure of severe acute respiratory syndrome coronavirus 2 (covid-19) antibody
|
138 | 66 | $84.26 | $42.13 |
|
82043
Urine microalbumin (protein) level
|
134 | 66 | $14.00 | $5.78 |
|
82607
Cyanocobalamin (vitamin B-12) level
|
134 | 64 | $34.00 | $15.08 |
|
84481
Thyroid hormone, t3 measurement, free
|
132 | 68 | $38.00 | $16.94 |
|
84439
Thyroxine (thyroid chemical), free
|
131 | 68 | $22.00 | $9.02 |
|
82570
Creatinine level to test for kidney function or muscle injury
|
120 | 60 | $12.00 | $5.18 |
|
82746
Folic acid level
|
111 | 61 | $34.00 | $14.70 |
|
83036
Hemoglobin A1C level
|
108 | 53 | $22.00 | $9.71 |
|
82306
Vitamin d-3 level
|
102 | 58 | $66.00 | $29.60 |
|
96372
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
|
92 | 42 | $50.00 | $14.09 |
|
83540
Iron level
|
71 | 38 | $16.00 | $6.47 |
|
83550
Iron binding capacity
|
70 | 37 | $20.00 | $8.74 |
|
82728
Ferritin (blood protein) level
|
66 | 38 | $32.00 | $13.63 |
|
99490
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month
|
62 | 30 | $82.00 | $41.01 |
|
J0696
Injection, ceftriaxone sodium, per 250 mg
|
56 | 11 | $1.00 | $0.52 |
|
J3420
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
|
45 | 23 | $4.00 | $1.99 |
|
G0439
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
|
42 | 42 | $234.00 | $133.37 |
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
38 | 27 | $146.74 | $87.87 |
|
G0444
Annual depression screening, 5 to 15 minutes
|
36 | 36 | $36.00 | $18.46 |
|
83735
Magnesium level
|
32 | 21 | $16.00 | $6.70 |
|
91301
Sarscov2 vac 100mcg/0.5ml im
|
27 | 27 | $0.02 | $0.01 |
|
83970
Parathormone (parathyroid hormone) level
|
26 | 18 | $92.00 | $41.28 |
|
0013A
Adm sarscov2 100mcg/0.5ml3rd
|
25 | 25 | $80.00 | $38.88 |
|
84550
Uric acid level, blood
|
24 | 17 | $12.00 | $4.52 |
|
G0008
Administration of influenza virus vaccine
|
23 | 23 | $34.70 | $16.59 |
|
84100
Phosphate level
|
22 | 17 | $12.00 | $4.74 |
|
99443
Telephone medical discussion with physician, 21-30 minutes
|
21 | 14 | $219.00 | $102.09 |
|
80307
Testing for presence of drug, by chemistry analyzers
|
19 | 12 | $125.00 | $62.14 |
|
90694
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage
|
16 | 16 | $122.00 | $66.43 |
|
G0103
Prostate cancer screening; prostate specific antigen test (psa)
|
11 | 11 | $42.00 | $19.31 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
499 | 119 | $217.31 | $98.27 |
|
36415
Insertion of needle into vein for collection of blood sample
|
183 | 76 | $6.00 | $2.98 |
|
80053
Blood test, comprehensive group of blood chemicals
|
161 | 70 | $24.00 | $10.49 |
|
85025
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
|
159 | 74 | $18.00 | $7.72 |
|
84443
Blood test, thyroid stimulating hormone (TSH)
|
150 | 70 | $38.00 | $16.70 |
|
80061
Blood test, lipids (cholesterol and triglycerides)
|
141 | 68 | $30.00 | $13.30 |
|
81003
Automated urinalysis test
|
124 | 60 | $6.00 | $2.23 |
|
82043
Urine microalbumin (protein) level
|
95 | 50 | $14.00 | $5.74 |
|
82570
Creatinine level to test for kidney function or muscle injury
|
93 | 49 | $12.00 | $5.14 |
|
96372
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
|
87 | 38 | $50.00 | $14.07 |
|
83036
Hemoglobin A1C level
|
86 | 41 | $22.00 | $9.66 |
|
84481
Thyroid hormone, t3 measurement, free
|
76 | 34 | $38.00 | $16.83 |
|
84439
Thyroxine (thyroid chemical), free
|
76 | 34 | $22.00 | $8.96 |
|
82607
Cyanocobalamin (vitamin B-12) level
|
74 | 50 | $34.00 | $15.02 |
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
67 | 39 | $147.73 | $64.11 |
|
82306
Vitamin d-3 level
|
67 | 43 | $66.00 | $29.40 |
|
99443
Telephone medical discussion with physician, 21-30 minutes
|
53 | 35 | $219.00 | $80.84 |
|
83550
Iron binding capacity
|
44 | 26 | $20.00 | $8.69 |
|
83540
Iron level
|
44 | 26 | $16.00 | $6.43 |
|
99490
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month
|
41 | 19 | $82.00 | $41.82 |
|
82746
Folic acid level
|
39 | 31 | $34.00 | $14.67 |
|
J3420
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
|
31 | 22 | $4.00 | $1.93 |
|
J1885
Injection, ketorolac tromethamine, per 15 mg
|
28 | 12 | $1.00 | $0.58 |
|
82728
Ferritin (blood protein) level
|
27 | 22 | $32.00 | $13.55 |
|
83970
Parathormone (parathyroid hormone) level
|
22 | 15 | $92.00 | $41.09 |
|
84550
Uric acid level, blood
|
20 | 13 | $12.00 | $4.50 |
|
84100
Phosphate level
|
16 | 11 | $12.00 | $4.72 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
579 | 128 | $187.64 | $107.53 |
|
36415
Insertion of needle into vein for collection of blood sample
|
183 | 77 | $6.00 | $2.94 |
|
J0696
Injection, ceftriaxone sodium, per 250 mg
|
144 | 19 | $8.14 | $0.57 |
|
80053
Blood test, comprehensive group of blood chemicals
|
142 | 72 | $26.24 | $11.51 |
|
85025
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
|
133 | 71 | $19.62 | $8.46 |
|
80061
Blood test, lipids (cholesterol and triglycerides)
|
116 | 67 | $33.11 | $14.58 |
|
84443
Blood test, thyroid stimulating hormone (TSH)
|
115 | 63 | $41.77 | $18.30 |
|
81003
Automated urinalysis test
|
110 | 62 | $10.42 | $2.44 |
|
96372
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
|
105 | 38 | $43.01 | $16.32 |
|
82043
Urine microalbumin (protein) level
|
75 | 50 | $9.01 | $4.77 |
|
82570
Creatinine level to test for kidney function or muscle injury
|
75 | 51 | $9.67 | $5.63 |
|
83036
Hemoglobin A1C level
|
74 | 38 | $24.27 | $10.57 |
|
84481
Thyroid hormone, t3 measurement, free
|
61 | 32 | $40.60 | $18.44 |
|
84439
Thyroxine (thyroid chemical), free
|
60 | 32 | $23.35 | $9.82 |
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
60 | 41 | $125.65 | $73.26 |
|
82607
Cyanocobalamin (vitamin B-12) level
|
55 | 35 | $37.70 | $16.41 |
|
83550
Iron binding capacity
|
41 | 25 | $21.95 | $9.52 |
|
83540
Iron level
|
40 | 25 | $16.81 | $7.05 |
|
82728
Ferritin (blood protein) level
|
38 | 25 | $34.54 | $14.85 |
|
82746
Folic acid level
|
35 | 24 | $36.75 | $16.01 |
|
J3420
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
|
28 | 11 | $7.64 | $1.79 |
|
82306
Vitamin d-3 level
|
26 | 22 | $72.17 | $32.23 |
|
90653
Vaccine for influenza for injection into muscle
|
25 | 25 | $110.00 | $56.01 |
|
G0008
Administration of influenza virus vaccine
|
24 | 24 | $34.04 | $16.24 |
|
J2930
Injection, methylprednisolone sodium succinate, up to 125 mg
|
17 | 12 | $14.06 | $6.33 |
|
G0328
Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
|
16 | 16 | $41.13 | $17.69 |
|
83970
Parathormone (parathyroid hormone) level
|
14 | 12 | $102.17 | $44.94 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
565 | 129 | $161.00 | $106.69 |
|
36415
Insertion of needle into vein for collection of blood sample
|
170 | 78 | $6.00 | $2.94 |
|
80053
Blood test, comprehensive group of blood chemicals
|
156 | 75 | $28.74 | $12.78 |
|
80061
Blood test, lipids (cholesterol and triglycerides)
|
118 | 69 | $36.44 | $16.20 |
|
85025
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
|
109 | 66 | $21.16 | $9.40 |
|
81003
Automated urinalysis test
|
94 | 52 | $15.00 | $2.71 |
|
84443
Blood test, thyroid stimulating hormone (TSH)
|
88 | 54 | $45.74 | $20.33 |
|
96372
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
|
72 | 28 | $37.00 | $20.00 |
|
83036
Hemoglobin A1C level
|
72 | 35 | $26.42 | $11.75 |
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
66 | 39 | $109.00 | $72.26 |
|
84439
Thyroxine (thyroid chemical), free
|
60 | 34 | $24.54 | $10.91 |
|
84481
Thyroid hormone, t3 measurement, free
|
56 | 34 | $42.80 | $20.50 |
|
82043
Urine microalbumin (protein) level
|
54 | 35 | $3.00 | $2.94 |
|
82570
Creatinine level to test for kidney function or muscle injury
|
54 | 35 | $7.00 | $6.26 |
|
82607
Cyanocobalamin (vitamin B-12) level
|
38 | 26 | $41.02 | $18.24 |
|
G0439
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
|
33 | 33 | $168.00 | $115.14 |
|
83540
Iron level
|
31 | 21 | $17.62 | $7.83 |
|
83550
Iron binding capacity
|
31 | 21 | $23.80 | $10.57 |
|
82306
Vitamin d-3 level
|
30 | 26 | $80.58 | $35.82 |
|
G0444
Annual depression screening, 5 to 15 minutes
|
30 | 30 | $27.00 | $17.58 |
|
90674
Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free
|
29 | 29 | $36.00 | $23.57 |
|
99215
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more
|
27 | 24 | $216.00 | $144.65 |
|
G0008
Administration of influenza virus vaccine
|
26 | 26 | $35.00 | $19.91 |
|
82728
Ferritin (blood protein) level
|
18 | 15 | $37.08 | $16.49 |
|
82746
Folic acid level
|
17 | 12 | $40.02 | $17.79 |
|
J2930
Injection, methylprednisolone sodium succinate, up to 125 mg
|
17 | 12 | $15.00 | $6.22 |
|
93000
Routine ekg using at least 12 leads including interpretation and report
|
12 | 11 | $30.00 | $16.79 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99214
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
|
545 | 145 | $161.00 | $106.05 |
|
36415
Insertion of needle into vein for collection of blood sample
|
137 | 78 | $6.00 | $2.94 |
|
80053
Blood test, comprehensive group of blood chemicals
|
122 | 78 | $28.74 | $11.95 |
|
99490
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month
|
120 | 39 | $43.00 | $41.81 |
|
85025
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
|
96 | 68 | $21.16 | $10.45 |
|
80061
Blood test, lipids (cholesterol and triglycerides)
|
91 | 61 | $36.44 | $14.19 |
|
84443
Blood test, thyroid stimulating hormone (TSH)
|
82 | 59 | $45.74 | $22.59 |
|
81003
Automated urinalysis test
|
82 | 54 | $15.00 | $3.02 |
|
96372
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
|
57 | 35 | $37.00 | $24.29 |
|
J0696
Injection, ceftriaxone sodium, per 250 mg
|
56 | 11 | $15.00 | $0.60 |
|
84481
Thyroid hormone, t3 measurement, free
|
54 | 37 | $42.80 | $21.14 |
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
52 | 42 | $109.00 | $71.49 |
|
84439
Thyroxine (thyroid chemical), free
|
51 | 37 | $24.54 | $12.12 |
|
83036
Hemoglobin A1C level
|
47 | 29 | $26.42 | $13.05 |
|
82607
Cyanocobalamin (vitamin B-12) level
|
41 | 33 | $41.02 | $20.27 |
|
82043
Urine microalbumin (protein) level
|
31 | 26 | $3.00 | $2.37 |
|
82570
Creatinine level to test for kidney function or muscle injury
|
31 | 26 | $7.00 | $6.86 |
|
82306
Vitamin d-3 level
|
27 | 22 | $80.58 | $39.80 |
|
83540
Iron level
|
24 | 19 | $17.62 | $8.70 |
|
83550
Iron binding capacity
|
23 | 18 | $23.80 | $11.75 |
|
82746
Folic acid level
|
20 | 17 | $40.02 | $19.77 |
|
G0444
Annual depression screening, 5 to 15 minutes
|
20 | 20 | $27.00 | $17.56 |
|
G0008
Administration of influenza virus vaccine
|
19 | 19 | $35.00 | $24.61 |
|
90674
Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free
|
19 | 19 | $36.00 | $23.57 |
|
99204
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more
|
19 | 19 | $251.00 | $163.47 |
Medical Specialties & State Licenses
CMS Verified: 2026-02-17
General Practice
Primary Specialty
NUCC Taxonomy Code: 208D00000X
State License
PR 14433
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Hospital & Practice Group Affiliations
Conviva Medical Center Management, Llc
876 Saxon Blvd, Orange City, FL 327638214
Phone: 3867740491
Practice Associates & Co-Workers
Healthcare professionals and specialists practicing at this location or sharing practice phone/fax
Dr. Manuel Crisanto
, MD
NPI 1558330662
Internal Medicine
Doctor of Medicine (M.D.)
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
📍
Updated Practice Location
December 10, 2024
Registered at 876 SAXON BLVD, ORANGE CITY, FL 327638214 (Tel: 3866689800)
📍
Updated Business Mailing Address
December 10, 2024
Registered at 6101 BLUE LAGOON DR STE 200, MIAMI, FL 331263168 (Tel: 3055002000)
📍
Updated Practice Location
April 15, 2022
Registered at 747 FAWN RIDGE DR STE 200, ORANGE CITY, FL 327638268 (Tel: 3866689800)
📍
Updated Business Mailing Address
April 15, 2022
Registered at 747 FAWN RIDGE DR STE 200, ORANGE CITY, FL 327638268 (Tel: 3866689800)
✅
NPI Profile Active
April 20, 2016
NPI status registered as active in NPPES database
📍
Updated Practice Location
April 20, 2016
Registered at 2 CALLE CEMENTERIO, JAYUYA, PR 006641452 (Tel: 7878280919)
📍
Updated Business Mailing Address
April 20, 2016
Registered at 2555 S VOLUSIA AVE, ORANGE CITY, FL 327639116 (Tel: 3867740401)
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Provider Name / Credentials Updated
April 20, 2016
Recorded as NANCY ORTIZ, MD
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Medical Taxonomy / Specialty Registered (Primary Specialty)
April 20, 2016
General Practice (License #14433 in PR)
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Initial NPI Registration & Enumeration
September 20, 2006
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
NPI Number:
1477650570
Entity Type:
Individual Provider
Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date:
September 20, 2006
Last Update:
February 17, 2026
Sole Proprietor:
No
Mailing Address
6101 Blue Lagoon Dr Ste 200
Miami, FL 331263168
Phone: 3055002000
Public Domain Record
This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
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