Provider Demographics
NPI:1700295318
Name:MARIA DE LOURDES ORTIZ, CSP
Entity Type:Organization
Organization Name:MARIA DE LOURDES ORTIZ, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DE LOURDES
Authorized Official - Last Name:ORTIZ-ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-630-7923
Mailing Address - Street 1:86 VIA MIRADERO
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3007
Mailing Address - Country:US
Mailing Address - Phone:787-745-0806
Mailing Address - Fax:787-745-0806
Practice Address - Street 1:86 VIA MIRADERO
Practice Address - Street 2:HACIENDA SAN JOSE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3007
Practice Address - Country:US
Practice Address - Phone:787-745-0806
Practice Address - Fax:787-745-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13806207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty