Provider Demographics
NPI:1629272158
Name:ORTIZ DAVILA, NANCY IVETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:IVETTE
Last Name:ORTIZ DAVILA
Suffix:
Gender:F
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:PO BOX 1740
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1740
Mailing Address - Country:US
Mailing Address - Phone:787-755-1836
Mailing Address - Fax:787-292-0360
Practice Address - Street 1:PLAZA 5 #RD 20 RIO CRISTAL
Practice Address - Street 2:ENCANTADA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-755-1836
Practice Address - Fax:787-292-0360
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics