Provider Demographics
NPI:1013979723
Name:SANTORY -ORTIZ, JULIO
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:
Last Name:SANTORY -ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JULIO
Other - Middle Name:
Other - Last Name:SANTORY-ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1454
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1454
Mailing Address - Country:US
Mailing Address - Phone:787-247-4782
Mailing Address - Fax:787-733-3678
Practice Address - Street 1:URB. LA INMACULADA C/1 # 103
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-3678
Practice Address - Fax:787-733-3678
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12699208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54693Medicare UPIN
GL986AMedicare PIN