Healthcare Provider Details

I. General information

NPI: 1033110275
Provider Name (Legal Business Name): HIRAM ORTEGA NIEVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 CALLE COLON
AGUADA PR
00602-3115
US

IV. Provider business mailing address

PO BOX 998
AGUADA PR
00602-0998
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-5455
  • Fax: 787-868-5455
Mailing address:
  • Phone: 787-868-5455
  • Fax: 787-868-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8159
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8159
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8159
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: