Provider Demographics
NPI:1477821056
Name:ORTIZ VAZQUEZ, LETICIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:ORTIZ VAZQUEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RAFAEL CORDERO AVE. PR-30
Mailing Address - Street 2:PLAZA CENTRO COMMERCIAL II
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-653-6929
Mailing Address - Fax:787-653-6948
Practice Address - Street 1:RAFAEL CORDERO AVE. PR-30
Practice Address - Street 2:PLAZA CENTRO COMMERCIAL II
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-6929
Practice Address - Fax:787-653-6948
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist