Healthcare Provider Details

I. General information

NPI: 1083518112
Provider Name (Legal Business Name): IVONNEMARIE PEREZ ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1305
BAYAMON PR
00960-1305
US

IV. Provider business mailing address

PO BOX 1305
BAYAMON PR
00960-1305
US

V. Phone/Fax

Practice location:
  • Phone: 787-995-2794
  • Fax:
Mailing address:
  • Phone: 787-995-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1199
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: