Provider Demographics
NPI:1255497996
Name:ORTIZ, ALICIA (LCDA)
Entity Type:Individual
Prefix:PROF
First Name:ALICIA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOMAS DE AIBONITO CARR 723 KM 1.4 INT.
Mailing Address - Street 2:P O BOX 606
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0606
Mailing Address - Country:US
Mailing Address - Phone:787-735-6391
Mailing Address - Fax:787-735-6391
Practice Address - Street 1:154 CALLE SAN JOSE E
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3531
Practice Address - Country:US
Practice Address - Phone:787-735-6391
Practice Address - Fax:787-735-6391
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist