Provider Demographics
NPI:1629221940
Name:ORTIZ-ROSARIO, JOSE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOSE DAVID
Middle Name:
Last Name:ORTIZ-ROSARIO
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:B20 VIA HORIZONTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4461
Mailing Address - Country:US
Mailing Address - Phone:787-752-7897
Mailing Address - Fax:787-769-0689
Practice Address - Street 1:A6 AVE ROBERTO SANCHEZ VILELLA
Practice Address - Street 2:CASTELLANA GARDENS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984-3762
Practice Address - Country:US
Practice Address - Phone:787-752-7897
Practice Address - Fax:787-768-0689
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18163207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHP096AOtherMEDICARE PTAN