Provider Demographics
NPI:1730145749
Name:PEREZ ORTIZ, DORIS R (MD)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:R
Last Name:PEREZ ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 VIA DEL RIO
Mailing Address - Street 2:VALLE SAN LUIS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3371
Mailing Address - Country:US
Mailing Address - Phone:787-384-3860
Mailing Address - Fax:
Practice Address - Street 1:33 AVE. MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-266-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR107412081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3620OtherPREFERRED MEDICAL CHOICE
PR9600019OtherHUMANA REFORMA
PR2502496OtherACAA
PR2-10741OtherCIGNA
PR600321OtherMEDICARE MUCHO MAS
PRF-30727Medicare UPIN
PR82918Medicare ID - Type Unspecified