Healthcare Provider Details

I. General information

NPI: 1902954142
Provider Name (Legal Business Name): EDNA G ORTIZ-SANABRIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CALLE DIEGO VEGA AMELIA
GUAYNABO PR
00965-5311
US

IV. Provider business mailing address

1645 CALLE TAMESIS
SAN JUAN PR
00926-2949
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-4479
  • Fax: 787-783-0059
Mailing address:
  • Phone: 787-765-1801
  • Fax: 787-763-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9589
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: