Provider Demographics
NPI:1215221999
Name:ORTIZ, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
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:CARR 107
Mailing Address - Street 2:KM3.1COMERCIAL PLAZA BORINQUEN
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5970
Mailing Address - Country:US
Mailing Address - Phone:787-819-1326
Mailing Address - Fax:787-819-0761
Practice Address - Street 1:CARR 107
Practice Address - Street 2:KM3.1COMERCIAL PLAZA BORINQUEN
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-819-1326
Practice Address - Fax:787-819-0761
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1827OtherPHAMACIST LICENCE