Provider Demographics
NPI:1336255389
Name:ORTIZ, CARMEN YAISMAR (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:YAISMAR
Last Name:ORTIZ
Suffix:
Gender:F
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:PR
Mailing Address - Zip Code:00721-0374
Mailing Address - Country:US
Mailing Address - Phone:787-887-8959
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 966, KM.3 HM.3
Practice Address - Street 2:BARRIO ZARZAL ARRIBA
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-477-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16491208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice