Provider Demographics
NPI:1295757417
Name:ORTIZ-DIAZ, MIGUEL ANGEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:ORTIZ-DIAZ
Suffix:
Gender:M
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:COND. LAGO PLAYA 3000
Mailing Address - Street 2:APT. 1732
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3051
Mailing Address - Country:US
Mailing Address - Phone:787-813-9524
Mailing Address - Fax:
Practice Address - Street 1:COND. LAGO PLAYA 3000
Practice Address - Street 2:APT. 1732
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3051
Practice Address - Country:US
Practice Address - Phone:787-813-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15703208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI49009Medicare UPIN
PR23554Medicare ID - Type Unspecified