Provider Demographics
NPI:1841288172
Name:ORTIZ-VILLALOBOS, MOISES (MD)
Entity type:Individual
Prefix:DR
First Name:MOISES
Middle Name:
Last Name:ORTIZ-VILLALOBOS
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:PO BOX 6628
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6628
Mailing Address - Country:US
Mailing Address - Phone:787-746-7441
Mailing Address - Fax:787-746-3190
Practice Address - Street 1:AVE.LUIS MUNOZ MARIN, MARIOLGA
Practice Address - Street 2:HOSPITAL HIMA OFICINA 106
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-746-7441
Practice Address - Fax:787-746-3190
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10714207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83602OtherTRIPLE S
PR4095OtherPREFERRED MEDICARE CHOICE
PR7250125OtherHUMANA HEALTH PLANS
PR3632OtherFIRST PLUS
PR4095OtherPREFERRED MEDICARE CHOICE
PR3632OtherFIRST PLUS