Individual ProviderRey Miranda OrtizDentistDental ProvidersPractice Address347 Gellert Blvd, Suite L, Daly City, CA 94015-2664(650) 992-7303PECOS EnrollmentBased on the most recent information from CMS, provider Rey Miranda Ortiz does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1639219231Provider TypeIndividualFull NameOrtiz, Rey MirandaCredentialDDSGenderMaleSole ProprietorYesEnumeration Date2/6/2007Last Updated7/9/2007Contact InformationPractice LocationPractice Address347 Gellert Blvd, Suite L, Daly City, CA 94015-2664Phone(650) 992-7303FaxUnlisted FaxMailing LocationMailing Address347 Gellert Blvd, Suite L, Daly City, CA 94015-2664Phone(650) 992-7303FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicenseDY030964CaliforniaProvider IdentifiersIDDescriptionIssuerIDDS0309640DescriptionMedicaidIssuerUnlistedCalifornia