Provider Demographics
NPI:1225367477
Name:ORTIZ, SANDRA (LPN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND SANTA MARIA 2
Mailing Address - Street 2:APT. 805
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4550
Mailing Address - Country:US
Mailing Address - Phone:787-662-2834
Mailing Address - Fax:
Practice Address - Street 1:COND SANTA MARIA 2
Practice Address - Street 2:APT. 805
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4550
Practice Address - Country:US
Practice Address - Phone:787-662-2834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21363164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse