Provider Demographics
NPI:1639236730
Name:ORTIZ, PEDRO J (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:J
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 1:1639 CALLE MARQUESA
Mailing Address - Street 2:URB VALLE REAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0502
Mailing Address - Country:US
Mailing Address - Phone:787-643-4467
Mailing Address - Fax:
Practice Address - Street 1:CENTRO PEDIATRICO
Practice Address - Street 2:AVE. TITO CASTRO 931 CARR. 14 BO MACHUELO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-843-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics