Provider Demographics
NPI:1720280506
Name:ORTIZ LARACUENTE, SABATO (MD)
Entity Type:Individual
Prefix:DR
First Name:SABATO
Middle Name:
Last Name:ORTIZ LARACUENTE
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 1:304 TORRE SAN CRISTOBAL
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2849
Mailing Address - Country:US
Mailing Address - Phone:787-848-6996
Mailing Address - Fax:787-848-6921
Practice Address - Street 1:304 TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2849
Practice Address - Country:US
Practice Address - Phone:787-848-6996
Practice Address - Fax:787-848-6921
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17489208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCQ258ZMedicare UPIN