MEDICARE: MRS. MARIA D 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	171000000X	Military Health Care Provider	000288	PR

General Provider Information

NPI Number	:	1699835793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA D ORTIZ

Provider Business Mailing Address
First Line	:	RURAL ROUTE # 4
Second Line	:	BOX 27463
City	:	TOA ALTA
State	:	PR
Zip	:	00953
Country	:	US
Telephone Number	:	787-707-2167
Fax Number	:	787-707-2159

Provider Business Practice Location Address
First Line	:	218 BROOK ST
Second Line	:	BLDG 21
City	:	FORT BUCHANAN
State	:	PR
Zip	:	00934-4206
Country	:	US
Telephone Number	:	787-707-2167
Fax Number	:	787-707-2159

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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