Provider Demographics
NPI:1598837007
Name:ALICEA ORTIZ, ANGEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:L
Last Name:ALICEA ORTIZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:L
Other - Last Name:ALICEA ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:CALLE ISABEL #223 MANSION REAL
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-840-4646
Mailing Address - Fax:787-840-4646
Practice Address - Street 1:1718 CARR. 506 MARGINAL
Practice Address - Street 2:SUITE 101
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2948
Practice Address - Country:US
Practice Address - Phone:787-840-4646
Practice Address - Fax:787-840-4646
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0583152W00000X
PR583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist