Provider Demographics
NPI:1255752960
Name:CENTRO VISUAL DR KELVIN ORTIZ PSC
Entity type:Organization
Organization Name:CENTRO VISUAL DR KELVIN ORTIZ PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-847-0091
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1511
Mailing Address - Country:US
Mailing Address - Phone:787-847-0091
Mailing Address - Fax:787-847-0091
Practice Address - Street 1:1 CALLE MCK JONES
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2228
Practice Address - Country:US
Practice Address - Phone:787-847-0091
Practice Address - Fax:787-847-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR550261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty