Healthcare Provider Details

I. General information

NPI: 1154548923
Provider Name (Legal Business Name): ELENA ORTIZ PHARMACIST TECH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. DOMINICOS ESQ. CALLE 25 MIRAFLORES
BAYAMON PR
00956
US

IV. Provider business mailing address

RR-8 BOX 1464
BAYAMON PR
00956-9611
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-9615
  • Fax: 787-797-2650
Mailing address:
  • Phone: 787-220-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number4729
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: