MEDICARE: ITZA M DORTA FERNANDEZ

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	231H00000X	Audiologist	0555	PR

General Provider Information

NPI Number	:	1558230862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITZA M DORTA FERNANDEZ

Provider Business Mailing Address
First Line	:	PO BOX 193069
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-3069
Country	:	US
Telephone Number	:	787-761-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	BARRIO HATO ARRIBA SUITE 18
Second Line	:	CARR 111 SAN SEBASTIAN
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-9998
Country	:	US
Telephone Number	:	787-280-0200
Fax Number	:

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

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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Directions to “ ITZA M DORTA FERNANDEZ ” Practice Location

Language	Start Address	Practice Location

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