Provider Demographics
NPI:1881400943
Name:ORTIZ-VIANA, ISMARI (PA)
Entity type:Individual
Prefix:
First Name:ISMARI
Middle Name:
Last Name:ORTIZ-VIANA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 CALLE BLANCO
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5107
Mailing Address - Country:US
Mailing Address - Phone:787-404-1061
Mailing Address - Fax:
Practice Address - Street 1:658 CALLE BLANCO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-5107
Practice Address - Country:US
Practice Address - Phone:787-404-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2405-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant