Healthcare Provider Details

I. General information

NPI: 1275746737
Provider Name (Legal Business Name): LUIS JAVIER ORTIZ NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO SALUD MENTAL MAYAGUEZ 410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1522
US

IV. Provider business mailing address

URB. EXTENSION ELIZABETH BUZON 5017
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax: 787-833-1371
Mailing address:
  • Phone: 787-851-3649
  • Fax: 787-833-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number21941
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: