Provider Demographics
NPI:1427604941
Name:DR LUIS CARLOS ORTIZ LLC
Entity Type:Organization
Organization Name:DR LUIS CARLOS ORTIZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MD
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-458-8030
Mailing Address - Street 1:BOX 160
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-851-2320
Mailing Address - Fax:787-851-2320
Practice Address - Street 1:48 HENNA ST
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-2320
Practice Address - Fax:787-851-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23461Medicaid