Healthcare Provider Details

I. General information

NPI: 1356317382
Provider Name (Legal Business Name): JORGE GUZMAN-ORTIZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE COROZAL ESQ PATRON 2
MOROVIS PR
00687
US

IV. Provider business mailing address

PO BOX 1046
TOA ALTA PR
00954-1046
US

V. Phone/Fax

Practice location:
  • Phone: 787-862-3000
  • Fax: 787-828-0259
Mailing address:
  • Phone: 787-412-3701
  • Fax: 787-862-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8677
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: