| Doctor Name: | MR. MARCUS RENE ORTIZ |
| NPI Number: | 1124303334 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA21940 |
| Business Practice Address: | 2301 E Foothill Blvd Suite 100 Glendora, CA - 917404000 |
| Business Phone Number: | 6268523376 |
| Business Fax Number: | 6268523375 |
| Mailing Address: | Po Box 16297, BEVERLY HILLS |
| State: | CA |
| Postal Code: | 902092297 |
| Phone Number: | 9092292406 |
| Fax Number: | |
| NPI Enumeration Date: | 10/19/2011 |
| NPI Last Update Date: | 04/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA21940 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |