MEDICARE: MYRIAM ARACELIS ORTIZ-DE JESUS' MD

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	208000000X	Pediatrics Physician	MD.09880R	LA
2	208000000X	Pediatrics Physician	16387	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033162300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAM ARACELIS ORTIZ-DE JESUS' MD

Provider Business Mailing Address
First Line	:	1514 JEFFERSON HWY
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70121-2429
Country	:	US
Telephone Number	:	504-842-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11424 SULLIVAN RD
Second Line	:	SUITE B1
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3615
Country	:	US
Telephone Number	:	225-761-5200
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/05/2017

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