Provider Demographics
NPI:1518284124
Name:ORTEGA, DAISY (LND)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:787-447-2641
Mailing Address - Fax:787-743-1338
Practice Address - Street 1:ROAD #1 KM 34.6
Practice Address - Street 2:CAGUITAS MALL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-447-2641
Practice Address - Fax:787-743-1338
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR754133N00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal