Provider Demographics
NPI:1255563458
Name:HENRY ORTIZ
Entity type:Organization
Organization Name:HENRY ORTIZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-420-8906
Mailing Address - Street 1:RR 1 BOX 37154
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9101
Mailing Address - Country:US
Mailing Address - Phone:787-420-8906
Mailing Address - Fax:
Practice Address - Street 1:CARR 423 KM 5.7 INTERIOR
Practice Address - Street 2:BO SONADOR SECTOR MONTALVO
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-9101
Practice Address - Country:US
Practice Address - Phone:787-420-8906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039027800Medicaid