Provider Demographics
NPI:1841584646
Name:ORTIZ, DARIZA
Entity Type:Individual
Prefix:
First Name:DARIZA
Middle Name:
Last Name: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:RIO CRISTAL 1373
Mailing Address - Street 2:AVE SANTITOS COLON
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1927
Mailing Address - Country:US
Mailing Address - Phone:787-504-1460
Mailing Address - Fax:
Practice Address - Street 1:RIO CRISTAL
Practice Address - Street 2:1373 AVE SANTITOS COLON
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1927
Practice Address - Country:US
Practice Address - Phone:787-504-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist