Provider Demographics
NPI:1134285588
Name:ORTIZ, MARIANGELY (CPHT)
Entity Type:Individual
Prefix:
First Name:MARIANGELY
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 10 BOX 7845
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9715
Mailing Address - Country:US
Mailing Address - Phone:787-821-5507
Mailing Address - Fax:787-821-5507
Practice Address - Street 1:121 RD KM 4.3
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653
Practice Address - Country:US
Practice Address - Phone:787-821-5507
Practice Address - Fax:787-821-5507
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17019183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician