Provider Demographics
NPI:1083711428
Name:ORTIZ, JOSE SR (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ORTIZ
Suffix:SR
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:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0013
Mailing Address - Country:US
Mailing Address - Phone:787-884-6572
Mailing Address - Fax:787-854-3153
Practice Address - Street 1:CDT MUNICIPAL
Practice Address - Street 2:CARR 2 KILOMETRO 50
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-5225
Practice Address - Fax:787-854-3153
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11411173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084492Medicare ID - Type Unspecified