Healthcare Provider Details

I. General information

NPI: 1821169335
Provider Name (Legal Business Name): MR. JOSE A ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 14 KM 47.6 BARRIO ASOMANTE
AIBONITO PR
00705-0611
US

IV. Provider business mailing address

PO BOX 611
AIBONITO PR
00705-0611
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-0075
  • Fax: 787-991-0075
Mailing address:
  • Phone: 787-991-0075
  • Fax: 787-991-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number08-P-1570
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: