Provider Demographics
NPI:1417018029
Name:ORTIZ, MAUREEN (RPH)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
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:URB.MONTECLARO ESTATES
Mailing Address - Street 2:ME 52 CALLE PLAZA 14
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-642-1008
Mailing Address - Fax:787-777-0409
Practice Address - Street 1:URB.MONTECLARO ESTATES
Practice Address - Street 2:ME 52 CALLE PLAZA 14
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-642-1008
Practice Address - Fax:787-777-0409
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist