Healthcare Provider Details

I. General information

NPI: 1265837512
Provider Name (Legal Business Name): HECTOR ANTONIO ORTIZ MIRANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CALLE LA FUENTE VILLAS DEL PRADO
JUANA DIAZ PR
00795-2760
US

IV. Provider business mailing address

700 CALLE LA FUENTE VILLAS DEL PRADO
JUANA DIAZ PR
00795-2760
US

V. Phone/Fax

Practice location:
  • Phone: 939-777-1009
  • Fax:
Mailing address:
  • Phone: 939-777-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number18926
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: