Provider Demographics
NPI:1386862787
Name:ORTIZ, CARMEN M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA UNIVERSITARIA BE-4 29
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4358
Mailing Address - Country:US
Mailing Address - Phone:787-852-6851
Mailing Address - Fax:
Practice Address - Street 1:RYDER MEMORIAL HOSPITAL
Practice Address - Street 2:AVE.FONT MARTELO 355
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:787-850-1444
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist