Provider Demographics
NPI:1659751766
Name:ORTIZ NIEVES, LIZAIRA
Entity Type:Individual
Prefix:
First Name:LIZAIRA
Middle Name:
Last Name:ORTIZ NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 69 BOX 15544
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-780-7383
Mailing Address - Fax:787-780-7389
Practice Address - Street 1:CARR 174 KM 10.2
Practice Address - Street 2:BO GUARAGUAO SEC. LA MORENITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-780-7383
Practice Address - Fax:787-780-7389
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9445183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician