Healthcare Provider Details

I. General information

NPI: 1821915596
Provider Name (Legal Business Name): EDIANITH ORTIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1316
AIBONITO PR
00705-1316
US

IV. Provider business mailing address

PO BOX 1316
AIBONITO PR
00705-1316
US

V. Phone/Fax

Practice location:
  • Phone: 939-209-4507
  • Fax:
Mailing address:
  • Phone: 939-209-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25192
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: