Provider Demographics
NPI:1437223625
Name:ORTIZ, GRISEL (PH)
Entity Type:Individual
Prefix:MRS
First Name:GRISEL
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. CAONILLAS CARR. #726
Mailing Address - Street 2:HC 01 BOX 3578
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-991-2107
Mailing Address - Fax:787-735-2500
Practice Address - Street 1:59 CALLE SAN JOSE E
Practice Address - Street 2:BOX 2021
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3534
Practice Address - Country:US
Practice Address - Phone:787-735-2401
Practice Address - Fax:787-735-2500
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist