Provider Demographics
NPI:1144491010
Name:RODRIGUEZ ORTIZ, MARILYN (MD)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:RODRIGUEZ ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:5840 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7558
Practice Address - Country:US
Practice Address - Phone:407-720-7302
Practice Address - Fax:407-293-1355
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17013208D00000X
FLACN956208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN956OtherFLORIDA MEDICAL LICENSE
FLACN956OtherFLORIDA MEDICAL LICENSE