Provider Demographics
NPI:1245469063
Name:ORTIZ, JOHANNA SABEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:SABEL
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 1810 PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:ROSARIO
Mailing Address - State:PR
Mailing Address - Zip Code:00636
Mailing Address - Country:US
Mailing Address - Phone:787-439-7029
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 348 KM 9.7
Practice Address - Street 2:ROSARIO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00636
Practice Address - Country:US
Practice Address - Phone:787-439-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice