Provider Demographics
NPI:1497353791
Name:CLINICA MEDICINA PRIMARIA Y PREVENTIVA DR ANGEL M ORTIZ ORTEGA
Entity Type:Organization
Organization Name:CLINICA MEDICINA PRIMARIA Y PREVENTIVA DR ANGEL M ORTIZ ORTEGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:ORTIZ ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-239-9333
Mailing Address - Street 1:PO BOX 6032
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6032
Mailing Address - Country:US
Mailing Address - Phone:787-421-4068
Mailing Address - Fax:
Practice Address - Street 1:BO TOMAS DE CASTRO 2, CARR 183 KM 4.8
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-239-9333
Practice Address - Fax:939-945-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4615292OtherDRIVER LICENCE