Healthcare Provider Details

I. General information

NPI: 1306064431
Provider Name (Legal Business Name): MARIA A ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PARQUE Y ROSSI TERMINAL TOMAS KUILAN 4A
BAYAMON PR
00960-0000
US

IV. Provider business mailing address

PO BOX 9501
BAYAMON PR
00960-9501
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-7288
  • Fax:
Mailing address:
  • Phone: 787-780-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number743
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: