Provider Demographics
NPI:1649230442
Name:ORTIZ, LUIS CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:CARLOS
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:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-851-2320
Mailing Address - Fax:787-851-2320
Practice Address - Street 1:BALDORIOTY ST 68
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-2320
Practice Address - Fax:787-851-2320
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15587208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23461Medicare ID - Type Unspecified
PRI48076Medicare UPIN