Provider Demographics
NPI:1932480746
Name:ORTIZ, JULIAN SR (LO)
Entity Type:Individual
Prefix:MRS
First Name:JULIAN
Middle Name:
Last Name:ORTIZ
Suffix:SR
Gender:M
Credentials:LO
Other - Prefix:MRS
Other - First Name:JULIAN
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:LO
Mailing Address - Street 1:206 CALLE VIOLETA
Mailing Address - Street 2:URB. LOIZA VALLEY
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3549
Mailing Address - Country:US
Mailing Address - Phone:787-876-8409
Mailing Address - Fax:
Practice Address - Street 1:URB LOIZA VALLEY 206 VIOLETA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-5000
Practice Address - Fax:787-876-2422
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR597156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician