Provider Demographics
NPI:1699835793
Name:ORTIZ, MARIA D
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:D
Last Name:ORTIZ
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:RURAL ROUTE # 4
Mailing Address - Street 2:BOX 27463
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-707-2167
Mailing Address - Fax:787-707-2159
Practice Address - Street 1:218 BROOK ST
Practice Address - Street 2:BLDG 21
Practice Address - City:FORT BUCHANAN
Practice Address - State:PR
Practice Address - Zip Code:00934-4206
Practice Address - Country:US
Practice Address - Phone:787-707-2167
Practice Address - Fax:787-707-2159
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000288171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider