Provider Demographics
NPI:1407833775
Name:ORTIZ-ESPADA, CARLOS A (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:ORTIZ-ESPADA
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 1:909 CALLE ROCHESTER
Mailing Address - Street 2:UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4812
Mailing Address - Country:US
Mailing Address - Phone:787-767-8222
Mailing Address - Fax:787-281-7437
Practice Address - Street 1:728 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4500
Practice Address - Country:US
Practice Address - Phone:787-767-8222
Practice Address - Fax:787-281-7437
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1976OtherSTAE MEDICAL LICENS NUMBE