Provider Demographics
NPI:1720226392
Name:ORTIZ, IDALIA B (CRNA)
Entity Type:Individual
Prefix:
First Name:IDALIA
Middle Name:B
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5195
Mailing Address - Street 2:CARR 155 KM.-23.1
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-9216
Mailing Address - Country:US
Mailing Address - Phone:787-867-3829
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 5195
Practice Address - Street 2:CARR 155 KM.-23.1
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-9216
Practice Address - Country:US
Practice Address - Phone:787-867-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR71257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered