Provider Demographics
NPI:1770625402
Name:ORTIZ, PRAXEDES B
Entity type:Individual
Prefix:MR
First Name:PRAXEDES
Middle Name:B
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET INDIERA BAJA 426 ROAD KM 3.2
Mailing Address - Street 2:RR01 BUZON 4000
Mailing Address - City:MARICAO
Mailing Address - State:PR
Mailing Address - Zip Code:00606-9705
Mailing Address - Country:US
Mailing Address - Phone:787-838-3422
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 4000
Practice Address - Street 2:
Practice Address - City:MARICAO
Practice Address - State:PR
Practice Address - Zip Code:00606-9705
Practice Address - Country:US
Practice Address - Phone:787-838-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004730183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004730OtherHEALTH DEPARTMENT OF PR