Provider Demographics
NPI:1558907691
Name:ORTIZ LOPEZ, LIZ MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZ
Middle Name:MARIE
Last Name:ORTIZ LOPEZ
Suffix:
Gender:F
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:PO BOX 51038
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1038
Mailing Address - Country:US
Mailing Address - Phone:787-349-6818
Mailing Address - Fax:
Practice Address - Street 1:URB. JARDINES DE MONTE OLIVO
Practice Address - Street 2:# 1 CALLE HERA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-349-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1605208D00000X
PR21598208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice