Provider Demographics
NPI:1245881986
Name:ORTA, SANDRA IVETTE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:IVETTE
Last Name:ORTA
Suffix:
Gender:F
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 245
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0245
Mailing Address - Country:US
Mailing Address - Phone:787-608-8396
Mailing Address - Fax:
Practice Address - Street 1:URB LOMAS DEL SOL
Practice Address - Street 2:CALLE ACUARIO 5
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-8909
Practice Address - Country:US
Practice Address - Phone:787-608-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider