Provider Demographics
NPI:1740713643
Name:ORTIZ, GONZALO
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6263
Mailing Address - Country:US
Mailing Address - Phone:407-893-8200
Mailing Address - Fax:407-893-8210
Practice Address - Street 1:741 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9226
Practice Address - Country:US
Practice Address - Phone:800-255-7188
Practice Address - Fax:407-423-9040
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148138207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology