Healthcare Provider Details

I. General information

NPI: 1407114945
Provider Name (Legal Business Name): VIVIANA ORTIZ SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BS AVE LAS AMERICAS URB BAIROA
CAGUAS PR
00727-0001
US

IV. Provider business mailing address

1575 AVE. MUNOZ RIVERA PMB 121
PONCE PR
00717-0211
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-7066
  • Fax: 787-946-9401
Mailing address:
  • Phone: 787-974-7868
  • Fax: 787-946-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number18803
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: