Provider Demographics
NPI:1891051819
Name:DRA VILMA ORTEGA VIDAURRE GYNECOLOGIST AND OBSTETRICIAN, PSC
Entity Type:Organization
Organization Name:DRA VILMA ORTEGA VIDAURRE GYNECOLOGIST AND OBSTETRICIAN, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA-VIDAURRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-754-8333
Mailing Address - Street 1:239 AVE ARTERIAL HOSTOS
Mailing Address - Street 2:CAPITAL CENTER BLDG. SUITE 601
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1474
Mailing Address - Country:US
Mailing Address - Phone:787-754-8333
Mailing Address - Fax:
Practice Address - Street 1:239 AVE ARTERIAL HOSTOS
Practice Address - Street 2:CAPITAL CENTER BLDG. SUITE 601
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1474
Practice Address - Country:US
Practice Address - Phone:787-754-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12220261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty