Provider Demographics
NPI:1538109822
Name:ORTIZ, MARIA LOURDES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LOURDES
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:LOURDES
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:HC 06 BOX 19660
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-650-1363
Mailing Address - Fax:787-650-1363
Practice Address - Street 1:HC 06 BOX 19660
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-1363
Practice Address - Fax:787-650-1363
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14416208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI07393Medicare UPIN
PR21471Medicare ID - Type Unspecified