Provider Demographics
NPI:1336125368
Name:ORTEGA, HIRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:
Last Name:ORTEGA
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:HC 3 BOX 39603
Mailing Address - Street 2:HC03 BOX 39603
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9794
Mailing Address - Country:US
Mailing Address - Phone:787-868-0345
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 39603
Practice Address - Street 2:HC03 BOX 39603
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9794
Practice Address - Country:US
Practice Address - Phone:787-868-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
21282Medicare ID - Type Unspecified
PRH79749Medicare UPIN