Provider Demographics
NPI:1407114945
Name:ORTIZ SANTIAGO, VIVIANA
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:ORTIZ SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 AVE. MUNOZ RIVERA
Mailing Address - Street 2:PMB 121
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0211
Mailing Address - Country:US
Mailing Address - Phone:787-974-7868
Mailing Address - Fax:787-946-9401
Practice Address - Street 1:4 BS AVE LAS AMERICAS
Practice Address - Street 2:URB BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-0001
Practice Address - Country:US
Practice Address - Phone:787-746-7066
Practice Address - Fax:787-946-9401
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18803207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty