MEDICARE: DR. JAIME LUIS ORTIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	009602	PR

General Provider Information

NPI Number	:	1003808171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME LUIS ORTIZ

Provider Business Mailing Address
First Line	:	PO BOX 1435
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-1435
Country	:	US
Telephone Number	:	787-844-5121
Fax Number	:	787-842-5796

Provider Business Practice Location Address
First Line	:	TORRE SAN CRISTOBAL
Second Line	:	205 A
City	:	COTO LAUREL
State	:	PR
Zip	:	00780
Country	:	US
Telephone Number	:	787-844-5121
Fax Number	:	787-842-5796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/08/2019

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