Healthcare Provider Details

I. General information

NPI: 1376547877
Provider Name (Legal Business Name): LILIAM ORTIZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CALLE MANUEL CRUZ
HUMACAO PR
00791-3627
US

IV. Provider business mailing address

PO BOX 6017
CAGUAS PR
00726-6017
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-8255
  • Fax: 787-852-1579
Mailing address:
  • Phone: 787-852-8255
  • Fax: 787-852-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2452
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: