Provider Demographics
NPI:1568618049
Name:SANTOS ORTIZ, EVELYN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:SANTOS ORTIZ
Suffix:
Gender:F
Credentials:RPT
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 1540
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1540
Mailing Address - Country:US
Mailing Address - Phone:787-657-9624
Mailing Address - Fax:787-657-9624
Practice Address - Street 1:CARR. 9960 KM 0.3 SECTOR BELLA VISTA,
Practice Address - Street 2:BO. EL VERDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-657-9624
Practice Address - Fax:787-657-9624
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist