Provider Demographics
NPI:1245379304
Name:ORTIZ MUNIZ, WANDA E (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:E
Last Name:ORTIZ MUNIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:ENID
Other - Last Name:ORTIZ MUNIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1036
Mailing Address - Country:US
Mailing Address - Phone:787-884-5368
Mailing Address - Fax:787-884-0881
Practice Address - Street 1:A4 CALLE MARGINAL
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4903
Practice Address - Country:US
Practice Address - Phone:787-884-5368
Practice Address - Fax:787-884-0881
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8867207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1259AOtherPMC PROVIDER NUMBER
PR214148OtherPREFERRED HEALTH PROV NUM
PR82283OROtherTRIPLE S PROVIDER NUMBER
PR600683OtherMMM PROVIDER NUMBER
PR060032OtherCRUZ AZUL PROV NUMBER
PR7010026OtherHUMANA PROVIDER NUMBER
PRE70853Medicare UPIN
PR82283Medicare ID - Type UnspecifiedPROVIDER NUMBER