MEDICARE: DR. LEONARDO 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	174400000X	Specialist	9582	PR
2	208000000X	Pediatrics Physician	9582	PR

General Provider Information

NPI Number	:	1891771697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARDO ORTIZ

Provider Business Mailing Address
First Line	:	55 CALLE VEREDA
Second Line	:	URB. MONTE VERDE REAL
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-600-1321
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 AVE LAS CUMBRES
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5523
Country	:	US
Telephone Number	:	787-720-5050
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	08/15/2014

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Directions to “ DR. LEONARDO ORTIZ ” Practice Location

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