Provider Demographics
NPI:1669004677
Name:ORTIZ BUSTILLO, MANUEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:JOSE
Last Name:ORTIZ BUSTILLO
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:URB MANSINES DE CIUDAD JARDIN
Mailing Address - Street 2:432 CALLE TARRAGONA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-618-7696
Mailing Address - Fax:
Practice Address - Street 1:URB MANSINES DE CIUDAD JARDIN
Practice Address - Street 2:432 CALLE TARRAGONA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-618-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21657208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice