Provider Demographics
NPI:1336861004
Name:ORTIZ, ANGEL (PA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IF21 CALLE CRUZ DE MALTA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3107
Mailing Address - Country:US
Mailing Address - Phone:787-478-0998
Mailing Address - Fax:
Practice Address - Street 1:TORRE AUXILIO MUTUO SUITE #715
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-0091
Practice Address - Country:US
Practice Address - Phone:787-250-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical