Provider Demographics
NPI:1265837512
Name:ORTIZ MIRANDA, HECTOR ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:ANTONIO
Last Name:ORTIZ MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CALLE LA FUENTE
Mailing Address - Street 2:VILLAS DEL PRADO
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-2760
Mailing Address - Country:US
Mailing Address - Phone:939-777-1009
Mailing Address - Fax:
Practice Address - Street 1:700 CALLE LA FUENTE
Practice Address - Street 2:VILLAS DEL PRADO
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-2760
Practice Address - Country:US
Practice Address - Phone:939-777-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18926282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18926Medicaid