Provider Demographics
NPI:1083854301
Name:ORTIZ, ILIA NORIS (PT)
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:NORIS
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DEL GOLF CLUB 776
Mailing Address - Street 2:TITE CURET ST.
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0550
Mailing Address - Country:US
Mailing Address - Phone:787-452-3510
Mailing Address - Fax:
Practice Address - Street 1:ESTANCIAS DEL GOLF CLUB 776
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-0550
Practice Address - Country:US
Practice Address - Phone:787-452-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1200172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker