Provider Demographics
NPI:1083810162
Name:ORTIZ HEREDIA, LUIS ANTONIO
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:ORTIZ HEREDIA
Suffix:
Gender:M
Credentials:
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 335251
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-5251
Mailing Address - Country:US
Mailing Address - Phone:787-362-0722
Mailing Address - Fax:
Practice Address - Street 1:CARIBBEAN MEDICAL CENTER PONCE BY PASS 2275
Practice Address - Street 2:SUITE 202
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0020
Practice Address - Country:US
Practice Address - Phone:787-840-1455
Practice Address - Fax:787-848-4657
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16621207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology