Provider Demographics
NPI:1982046025
Name:ORTIZ, DANIEL ALEXANDER (RN,BSN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ESTRELLA COND BAYOLA APT 1201B
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00907
Mailing Address - Country:UM
Mailing Address - Phone:787-698-0796
Mailing Address - Fax:
Practice Address - Street 1:STRET ESTRELLA 1447 EDIF BAYOLA APT 1201 B
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-698-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35403 G163WC0400X, 163WC3500X, 163WH0200X, 163WI0500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$Medicaid