Provider Demographics
NPI:1255428892
Name:ORTIZ, LIZVETTE (DENTIST)
Entity type:Individual
Prefix:MRS
First Name:LIZVETTE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:DENTIST
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 930
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0930
Mailing Address - Country:US
Mailing Address - Phone:787-255-0065
Mailing Address - Fax:787-255-0065
Practice Address - Street 1:CARRETERA 100 KM 5.8 INT #2300
Practice Address - Street 2:BARRIO MIRADERO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-255-0065
Practice Address - Fax:787-255-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice