Provider Demographics
NPI:1417150434
Name:ORTIZ, CARMEN A. CUSTODIO (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN A.
Middle Name:CUSTODIO
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 11 BOX 3745
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9312
Mailing Address - Country:US
Mailing Address - Phone:787-730-2132
Mailing Address - Fax:787-391-8624
Practice Address - Street 1:RR 11 BOX 3745
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9312
Practice Address - Country:US
Practice Address - Phone:787-730-2132
Practice Address - Fax:787-391-8624
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1065176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife