Healthcare Provider Details

I. General information

NPI: 1710985502
Provider Name (Legal Business Name): EDGARDO J ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDGARDO J ORTIZ M.D.

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS A. PORRATA PILA
PONCE PR
00717-2113
US

IV. Provider business mailing address

2431 AVE LAS AMERICAS A. PORRATA PILA
PONCE PR
00717-2114
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-7230
  • Fax: 787-848-7648
Mailing address:
  • Phone: 787-840-7230
  • Fax: 787-848-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number6882
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number6882
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: