Provider Demographics
NPI:1801109244
Name:ORTIZ, TAHIMY
Entity type:Individual
Prefix:MRS
First Name:TAHIMY
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CALLE AGUAS BUENAS
Mailing Address - Street 2:URB. BONNEVILLE HEIGHTS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-4947
Mailing Address - Country:US
Mailing Address - Phone:787-743-9977
Mailing Address - Fax:787-744-8733
Practice Address - Street 1:19 CALLE AGUAS BUENAS
Practice Address - Street 2:URB. BONNEVILLE HEIGHTS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-4947
Practice Address - Country:US
Practice Address - Phone:787-743-9977
Practice Address - Fax:787-744-8733
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier