Provider Demographics
NPI:1639164585
Name:DIETRICH ORMACHEA, RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:DIETRICH ORMACHEA
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:PO BOX 602727
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6037
Mailing Address - Country:US
Mailing Address - Phone:787-780-9069
Mailing Address - Fax:787-780-2121
Practice Address - Street 1:1815 ROAD NO 2 KM 11.7
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7279
Practice Address - Country:US
Practice Address - Phone:787-780-9069
Practice Address - Fax:787-780-2121
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4221207U00000X, 2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E97926Medicare UPIN
PR82500Medicare ID - Type Unspecified