Provider Demographics
NPI:1821169335
Name:ORTIZ, JOSE A
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0611
Mailing Address - Country:US
Mailing Address - Phone:787-991-0075
Mailing Address - Fax:787-991-0075
Practice Address - Street 1:CARR 14 KM 47.6
Practice Address - Street 2:BARRIO ASOMANTE
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-0611
Practice Address - Country:US
Practice Address - Phone:787-991-0075
Practice Address - Fax:787-991-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08-P-1570332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4038910001Medicare NSC