MEDICARE: OMAYRA MARISOL ORTIZ ALICEA

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	390200000X	Student in an Organized Health Care Education/Training Program	99881	PR

General Provider Information

NPI Number	:	1063344497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAYRA MARISOL ORTIZ ALICEA

Provider Business Mailing Address
First Line	:	URB. CONDADO MODERNO CALLE 1 E12
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	786-521-5716
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIVERSIDAD DE PUERTO RICO,RECINTO DE CIENCIAS MEDICAS
Second Line	:	PASEO DR. JOSE CELSO BARBOSA
City	:	SAN JUAN
State	:	PR
Zip	:	00921
Country	:	US
Telephone Number	:	787-758-2525
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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