Provider Demographics
NPI:1114998929
Name:GONZALEZ-ORTIZ, DORIS (PHD)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:GONZALEZ-ORTIZ
Suffix:
Gender:F
Credentials:PHD
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 231
Mailing Address - Street 2:
Mailing Address - City:SAINT JUST
Mailing Address - State:PR
Mailing Address - Zip Code:00978-0231
Mailing Address - Country:US
Mailing Address - Phone:787-622-4433
Mailing Address - Fax:787-622-4432
Practice Address - Street 1:AVE. LOMAS VERDES #1733
Practice Address - Street 2:RIO PIEDRAS HEIGHTS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-622-4433
Practice Address - Fax:787-622-4432
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
63152Medicare ID - Type Unspecified