Provider Demographics
NPI:1669749826
Name:JUANITA LOPEZ ORTIZ
Entity type:Organization
Organization Name:JUANITA LOPEZ ORTIZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-732-6787
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-0621
Mailing Address - Country:US
Mailing Address - Phone:787-732-6787
Mailing Address - Fax:787-732-6787
Practice Address - Street 1:CARRETERA 156 KM.49.5
Practice Address - Street 2:BARRIO SUMIDERO
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-732-6787
Practice Address - Fax:787-732-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR935261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1003139015OtherNPI (INDIVIDUAL)