Provider Demographics
NPI:1417667056
Name:ORTIZ-DIAZ, JUAN ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ENRIQUE
Last Name:ORTIZ-DIAZ
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 1:40 CALLE EL VIGIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-2987
Mailing Address - Country:US
Mailing Address - Phone:787-239-9557
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE EL VIGIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-2987
Practice Address - Country:US
Practice Address - Phone:787-239-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant