Provider Demographics
NPI:1508812223
Name:ORELLANA BERTRAN, JOSE EDMUNDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EDMUNDO
Last Name:ORELLANA BERTRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LD-77
Mailing Address - Street 2:VILLA ROMA LA ANTIGUA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:RI
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-268-7271
Mailing Address - Fax:787-268-7271
Practice Address - Street 1:LD-77
Practice Address - Street 2:VILLA ROMA LA ANTIGUA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:RI
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-268-7271
Practice Address - Fax:787-268-7271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7229207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine