Provider Demographics
NPI:1932873452
Name:ORTIZ VAZQUEZ, ISMAEL
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:ORTIZ VAZQUEZ
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 1:66 AVE BETANCES
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5201
Mailing Address - Country:US
Mailing Address - Phone:787-786-3656
Mailing Address - Fax:
Practice Address - Street 1:66 AVE BETANCES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5201
Practice Address - Country:US
Practice Address - Phone:787-786-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1759183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician