Provider Demographics
NPI:1780292540
Name:MONGE-ORTIZ, EVY MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:EVY
Middle Name:MARIE
Last Name:MONGE-ORTIZ
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H-152 EBANO ST. GOLDEN GATE
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-505-3424
Mailing Address - Fax:
Practice Address - Street 1:AVE. RAFAEL CORDERO FINAL ESQUINA TROCHE
Practice Address - Street 2:APT 1025
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1025
Practice Address - Country:US
Practice Address - Phone:787-745-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21863208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice