Provider Demographics
NPI:1942403084
Name:ORTIZ SANTIAGO, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:ORTIZ SANTIAGO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29 CALLE 2
Mailing Address - Street 2:GARDEN HILLS ESTATES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2907
Mailing Address - Country:US
Mailing Address - Phone:787-485-0419
Mailing Address - Fax:787-961-0091
Practice Address - Street 1:CENTRO COMERCIAL LOS PRADOS
Practice Address - Street 2:SUITE E
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9507
Practice Address - Country:US
Practice Address - Phone:787-961-0091
Practice Address - Fax:787-961-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2023-04-04
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Provider Licenses
StateLicense IDTaxonomies
PR16828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027489Medicare PIN