Healthcare Provider Details

I. General information

NPI: 1801911037
Provider Name (Legal Business Name): LUCRECIA ORTEGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 70 BLOQUE 84 NUM. 11 SIERRA BAYAMON
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 8946
BAYAMON PR
00960-8946
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-5354
  • Fax: 787-740-7646
Mailing address:
  • Phone: 787-778-5353
  • Fax: 787-740-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4875
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: