Provider Demographics
NPI:1508004151
Name:ORTIZ, RICARDO L
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:L
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:LUIS
Other - Last Name:ORTIZ MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7616
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7616
Mailing Address - Country:US
Mailing Address - Phone:787-475-0081
Mailing Address - Fax:
Practice Address - Street 1:1646 CALLE DONCELLA
Practice Address - Street 2:URB SAN ANTONIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-475-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17476208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice