Provider Demographics
NPI:1477862530
Name:ORTIZ, GERALDO (ENFERMERO BSN)
Entity Type:Individual
Prefix:MRS
First Name:GERALDO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:ENFERMERO BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:QUIOTERAPIA DE PONCE RD#14 BO MACHUELO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-840-6935
Mailing Address - Fax:
Practice Address - Street 1:CENTRO DE SERVICIOS CON METADONA PONCE RD#14 BO MACHUEL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00732
Practice Address - Country:UM
Practice Address - Phone:787-840-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20763163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care