Provider Demographics
NPI:1790465391
Name:GARCIA ORTIZ, NICOLE DENNISE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENNISE
Last Name:GARCIA 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:HC 1 BOX 17120
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9029
Mailing Address - Country:US
Mailing Address - Phone:939-717-7994
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 R908 KM5.6 BO MARIANA II
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:939-717-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program