Provider Demographics
NPI:1124017215
Name:ORTIZ PAGAN, GLADYS DEL CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:DEL CARMEN
Last Name:ORTIZ PAGAN
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:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0593
Mailing Address - Country:US
Mailing Address - Phone:787-851-0165
Mailing Address - Fax:787-851-0165
Practice Address - Street 1:44 CALLE RIUS RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3437
Practice Address - Country:US
Practice Address - Phone:787-851-0165
Practice Address - Fax:787-851-0165
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7911208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1124017215OtherNPI
PRE43413Medicare UPIN
PR28883Medicare ID - Type Unspecified