Provider Demographics
NPI:1386844371
Name:ORTIZ-RIVERA, JUAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:L
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:PO BOX 8807
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8807
Mailing Address - Country:US
Mailing Address - Phone:787-843-1625
Mailing Address - Fax:787-812-0565
Practice Address - Street 1:CALLE MARINA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-843-1625
Practice Address - Fax:787-812-0565
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05287208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice