Provider Demographics
NPI:1497954960
Name:ORTIZ, MYRNALI
Entity Type:Individual
Prefix:MRS
First Name:MYRNALI
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U23 CALLE 7
Mailing Address - Street 2:EL ROSARIO 2
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5702
Mailing Address - Country:US
Mailing Address - Phone:787-223-2073
Mailing Address - Fax:
Practice Address - Street 1:U23 CALLE 7
Practice Address - Street 2:EL ROSARIO 2
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-5702
Practice Address - Country:US
Practice Address - Phone:787-223-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2772183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR06261972OtherBIRTH