Provider Demographics
NPI:1013920164
Name:ORTIZ MELENDEZ, JORGE L
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:ORTIZ MELENDEZ
Suffix:
Gender:M
Credentials:
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 51513
Mailing Address - Street 2:LEVITTOWN STATION
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1513
Mailing Address - Country:US
Mailing Address - Phone:787-795-2935
Mailing Address - Fax:787-784-0680
Practice Address - Street 1:V17 CALLE 10
Practice Address - Street 2:ALTURAS DE FLAMBOYAN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-8051
Practice Address - Country:US
Practice Address - Phone:787-795-2935
Practice Address - Fax:787-784-0680
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8154208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF-43989Medicare UPIN
PR0089512Medicare ID - Type UnspecifiedMEDICARE PR