Provider Demographics
NPI:1053936971
Name:ORTIZ, ALLISKAIR ANIBAL (MD)
Entity type:Individual
Prefix:
First Name:ALLISKAIR
Middle Name:ANIBAL
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALLISKAIR
Other - Middle Name:ANIBAL
Other - Last Name:ORTIZ DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3533 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-5465
Mailing Address - Fax:
Practice Address - Street 1:1311 E GENERAL CAVAZOS BLVD STE 303C
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7123
Practice Address - Country:US
Practice Address - Phone:361-592-3237
Practice Address - Fax:361-221-1856
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0822208000000X
TX261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health