Healthcare Provider Details

I. General information

NPI: 1609396886
Provider Name (Legal Business Name): JOSEAN ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date: 02/25/2020
Reactivation Date: 03/13/2020

III. Provider practice location address

CARR 633 KM 4 BARRIO BARAHONA LOCAL 2 SEGUNDA PLANTA
MOROVIS PR
00687-2101
US

IV. Provider business mailing address

CARR 633 KM 4.9 BARRIO BARAHONA LOCAL 2 SEGUNDA PLANTA AL LADO DE BARAHONA AUTO PARTS
MOROVIS PR
00687-2101
US

V. Phone/Fax

Practice location:
  • Phone: 787-915-5309
  • Fax:
Mailing address:
  • Phone: 787-915-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21124
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: