| NPI | 1548930498 |
|---|---|
| Former Name | STEPHANIE MARIE ORTIZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115127) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2021-11-03 |