Provider Demographics
NPI:1710326723
Name:ORTIZ MARTINEZ, MARIANA JUDITH (M D)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:JUDITH
Last Name:ORTIZ MARTINEZ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 130
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-706-1315
Mailing Address - Fax:787-781-5923
Practice Address - Street 1:1789 CARRETERA 21
Practice Address - Street 2:TORRE HOSPITAL METROPOLITANO SUITE 309
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-706-1315
Practice Address - Fax:787-781-5923
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19636207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology