Provider Demographics
NPI:1093261745
Name:ORTIZ-DIAZ, KRYSTAL DEL MAR (MD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DEL MAR
Last Name:ORTIZ-DIAZ
Suffix:
Gender:F
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:T15 CALLE 19
Mailing Address - Street 2:EXT. CAGUAX
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL PAVIA ARECIBO
Practice Address - Street 2:CARR 129 KM 1.0 AVE SAN LUIS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-650-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22317208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery