Healthcare Provider Details

I. General information

NPI: 1891783270
Provider Name (Legal Business Name): ERWIN R. ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CL-1 FIDALGO DIAZ AVE. VILLA FONTANA
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 4767 VALLE ARRIBA HEIGHTS STATION
CAROLINA PR
00984-4767
US

V. Phone/Fax

Practice location:
  • Phone: 787-701-4646
  • Fax: 787-757-2361
Mailing address:
  • Phone: 787-701-4646
  • Fax: 787-757-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10359
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: