Provider Demographics
NPI:1609396886
Name:ORTIZ, JOSEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEAN
Middle Name:
Last Name:ORTIZ
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 1:73 CALLE FCO RODRIGUEZ
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-2101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 CALLE HERNANDEZ CARRION STE 207
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4652
Practice Address - Country:US
Practice Address - Phone:787-614-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2023-08-24
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-03-13
Provider Licenses
StateLicense IDTaxonomies
PR21124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine