Provider Demographics
NPI:1134300791
Name:ORTIZ, WALESKA M
Entity Type:Individual
Prefix:
First Name:WALESKA
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOULEVARD DEL RIO I
Mailing Address - Street 2:#300 AVE. LOS FILTROS APT. 4208
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9218
Mailing Address - Country:US
Mailing Address - Phone:787-403-6234
Mailing Address - Fax:
Practice Address - Street 1:BOULEVARD DEL RIO # I
Practice Address - Street 2:#300 AVE. LOS FILTROS APT. 4208
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9215
Practice Address - Country:US
Practice Address - Phone:787-403-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1781183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician