Provider Demographics
NPI:1184106965
Name:ORTIZ ORTIZ, DANICA MARIEL (OD)
Entity type:Individual
Prefix:DR
First Name:DANICA
Middle Name:MARIEL
Last Name:ORTIZ ORTIZ
Suffix:
Gender:F
Credentials:OD
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 1192
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1192
Mailing Address - Country:US
Mailing Address - Phone:787-235-2240
Mailing Address - Fax:
Practice Address - Street 1:2320 CARR 100 STE 101
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4458
Practice Address - Country:US
Practice Address - Phone:787-254-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR740-435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist