Healthcare Provider Details

I. General information

NPI: 1598962821
Provider Name (Legal Business Name): MIGUEL ANGEL ORTIZ BOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA DEL CARMEN SUITE 3
COROZAL PR
00783-0620
US

IV. Provider business mailing address

URB. GOLDEN VILLAGE C-70 STREET PRIMAVERA
VEGA ALTA PR
00692-9759
US

V. Phone/Fax

Practice location:
  • Phone: 787-859-1901
  • Fax:
Mailing address:
  • Phone: 787-516-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner
License Number16553
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine
License Number16553
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: