Provider Demographics
NPI:1164840146
Name:ORTIZ, MARIEN (AUXILIAR DE FARMACIA)
Entity Type:Individual
Prefix:
First Name:MARIEN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:AUXILIAR DE FARMACIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-4 BOX 2866
Mailing Address - Street 2:CARR. 719 KM 1.5 BO. HELECHAL
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:939-579-2539
Mailing Address - Fax:
Practice Address - Street 1:CARR. 719 KM 1.5 BO. HELECHAL
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:939-579-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005650183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4236401OtherTARJETA DE IDENTIFICACION