Healthcare Provider Details

I. General information

NPI: 1407801764
Provider Name (Legal Business Name): DR. LUIS ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. LUIS ORTIZ

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND EL DUERO APTO 15 C
GUAYNABO PR
00969
US

IV. Provider business mailing address

COND EL DUERO APTO 15 C
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-1667
  • Fax:
Mailing address:
  • Phone: 787-720-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5087
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: