MEDICARE: DR. MANUEL AMADO ORTIZ-JUNCEDA

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	1223P0300X	Periodontics	733	PR

General Provider Information

NPI Number	:	1780958660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL AMADO ORTIZ-JUNCEDA

Provider Business Mailing Address
First Line	:	145 AVE HOSTOS
Second Line	:	EL MONTE SUR TH APT. G-512
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4258
Country	:	US
Telephone Number	:	787-764-8448
Fax Number	:	787-764-8448

Provider Business Practice Location Address
First Line	:	145 AVE HOSTOS
Second Line	:	EL MONTE SUR TH APT. G-512
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4258
Country	:	US
Telephone Number	:	787-764-8448
Fax Number	:	787-764-8448

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

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	02/24/2012

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