Provider Demographics
NPI:1275527780
Name:ORTIZ - JUSTINIANO, VICTOR N (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:N
Last Name:ORTIZ - JUSTINIANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:89 AVE DE DIEGO
Mailing Address - Street 2:PMB 646
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6370
Mailing Address - Country:US
Mailing Address - Phone:787-474-5423
Mailing Address - Fax:787-523-2768
Practice Address - Street 1:PUERTO RICO CHILDRENS HOSPITAL OFIC. 302
Practice Address - Street 2:CARR NUM. 2 KM 11.7 EDIF. MEDICAL PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-474-5423
Practice Address - Fax:787-523-2768
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-10-27
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Provider Licenses
StateLicense IDTaxonomies
PR46952086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2-5547OtherSSS
2-5547OtherSSS