Provider Demographics
NPI:1821568155
Name:ORTIZ SANTANA, EVANS JAYSON (MD)
Entity Type:Individual
Prefix:
First Name:EVANS
Middle Name:JAYSON
Last Name:ORTIZ SANTANA
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:QUINTAS DE DORADO
Mailing Address - Street 2:BOULEVARD B23
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4704
Mailing Address - Country:US
Mailing Address - Phone:787-967-3195
Mailing Address - Fax:
Practice Address - Street 1:QUINTAS DE DORADO
Practice Address - Street 2:BOULEVARD B23
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4704
Practice Address - Country:US
Practice Address - Phone:787-967-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21154208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice