Healthcare Provider Details

I. General information

NPI: 1265471866
Provider Name (Legal Business Name): JOSE RAUL ORTIZ-RUBIO M.D.,MPH,OMS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 PASEO DEL PUERTO URB VISTA BAHIA
PENUELAS PR
00624-9773
US

IV. Provider business mailing address

251 PASEO DEL PUERTO URB VISTA BAHIA
PENUELAS PR
00624-9773
US

V. Phone/Fax

Practice location:
  • Phone: 787-403-6416
  • Fax: 787-812-7777
Mailing address:
  • Phone: 787-403-6416
  • Fax: 787-812-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number9029
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: