Provider Demographics
NPI:1598932014
Name:CLINICA MEDICA DRA ORTIZ-LOPEZ INC
Entity Type:Organization
Organization Name:CLINICA MEDICA DRA ORTIZ-LOPEZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAMILLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ORTIZ-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-204-0936
Mailing Address - Street 1:PO BOX 8907
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 PEDRO ALBIZU CAMPOS
Practice Address - Street 2:4B SUITE NO 10 PLAZA SALINAS MALL
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-824-4967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15274OtherLICENSE
I42683Medicare UPIN
15274OtherLICENSE