Provider Demographics
NPI:1295838209
Name:ORTIZ RIVERA, LUIS J (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:J
Last Name:ORTIZ RIVERA
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:#3205 AVE ISLA VERDE
Mailing Address - Street 2:CONDO GALAXY #904
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4990
Mailing Address - Country:US
Mailing Address - Phone:787-728-2984
Mailing Address - Fax:787-769-2428
Practice Address - Street 1:CALLE 266 PB #30
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-0220
Practice Address - Country:US
Practice Address - Phone:787-769-7525
Practice Address - Fax:787-769-2428
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2652208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D32922Medicare UPIN
PRD32922Medicare ID - Type Unspecified