Provider Demographics
NPI:1356635650
Name:ORTIZ, RENE (SA-C)
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18756 STONE OAK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4790
Mailing Address - Country:US
Mailing Address - Phone:210-289-0996
Mailing Address - Fax:210-579-8601
Practice Address - Street 1:18756 STONE OAK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4790
Practice Address - Country:US
Practice Address - Phone:210-531-6443
Practice Address - Fax:210-579-8601
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11-123246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist