Provider Demographics
NPI:1720019169
Name:ORTIZ, NOEL A (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:A
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:M11 CALLE ROSA
Mailing Address - Street 2:PARQUES DE SANTA MARIA, RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6736
Mailing Address - Country:US
Mailing Address - Phone:787-763-5189
Mailing Address - Fax:787-763-5189
Practice Address - Street 1:CALLE I # 48
Practice Address - Street 2:EXT. HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-763-5189
Practice Address - Fax:787-763-5189
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4366207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002619AOtherMEDICARE GROUP PROVIDER #
PRE00142Medicare UPIN
PR25376Medicare ID - Type UnspecifiedPROVIDER NUMBER