Provider Demographics
NPI:1922080175
Name:ORTIZ ROSADO, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:ORTIZ ROSADO
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:PO BOX 7430
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7430
Mailing Address - Country:US
Mailing Address - Phone:787-843-9989
Mailing Address - Fax:787-840-7245
Practice Address - Street 1:507 CALLE FERROCARRIL
Practice Address - Street 2:URB. SANTA MARIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1111
Practice Address - Country:US
Practice Address - Phone:787-843-9989
Practice Address - Fax:787-840-7245
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6915208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery