Provider Demographics
NPI:1598962821
Name:ORTIZ BOU, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:ORTIZ BOU
Suffix:
Gender:M
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:URB. GOLDEN VILLAGE C-70
Mailing Address - Street 2:STREET PRIMAVERA
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9759
Mailing Address - Country:US
Mailing Address - Phone:787-516-0363
Mailing Address - Fax:
Practice Address - Street 1:PLAZA DEL CARMEN
Practice Address - Street 2:SUITE 3
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0620
Practice Address - Country:US
Practice Address - Phone:787-859-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16553202C00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner