Provider Demographics
NPI:1083059547
Name:ORTIZ-CARTAGENA, ISMAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:ORTIZ-CARTAGENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 CALLE VEREDA VERDE
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9622
Mailing Address - Country:US
Mailing Address - Phone:787-379-5037
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE SANTACRUZ SUITE 202
Practice Address - Street 2:INSTITUTO SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-6585
Practice Address - Fax:787-798-6590
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19286207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRMR465Medicaid