Provider Demographics
NPI:1457495053
Name:LUIS R ORTIZ
Entity Type:Organization
Organization Name:LUIS R ORTIZ
Other - Org Name:FARMACIA MODELO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-862-3525
Mailing Address - Street 1:16 AVE BUENA VISTA
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687
Mailing Address - Country:US
Mailing Address - Phone:787-862-3525
Mailing Address - Fax:787-862-1511
Practice Address - Street 1:16 AVE BUENA VISTA
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-862-3525
Practice Address - Fax:787-862-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15F25803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084319OtherPK