Provider Demographics
NPI:1972298909
Name:ORTIZ CRUZ, RAMON ANGEL SR (DR)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:ANGEL
Last Name:ORTIZ CRUZ
Suffix:SR
Gender:M
Credentials:DR
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 3
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0003
Mailing Address - Country:US
Mailing Address - Phone:787-974-8288
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL EMPORIUM 351 SUITE 203 PISO 2
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-376-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIW427AMedicaid