1205486255 NPI number — MRS. MARY LIZ PIZARRO ORTIZ CASE MANAGER

Table of content: MRS. MARY LIZ PIZARRO ORTIZ CASE MANAGER (NPI 1205486255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205486255 NPI number — MRS. MARY LIZ PIZARRO ORTIZ CASE MANAGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIZARRO ORTIZ
Provider First Name:
MARY
Provider Middle Name:
LIZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CASE MANAGER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205486255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 W VINE ST
Provider Second Line Business Mailing Address:
SUITE 278
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-900-5786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 W VINE ST STE 278
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-4673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-900-5786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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