Provider Demographics
NPI:1548141609
Name:ORTIZ, LARISSA N
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:N
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 FERN RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2333
Mailing Address - Country:US
Mailing Address - Phone:315-278-4185
Mailing Address - Fax:
Practice Address - Street 1:305 FERN RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-2333
Practice Address - Country:US
Practice Address - Phone:315-278-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula