Healthcare Provider Details

I. General information

NPI: 1639236730
Provider Name (Legal Business Name): PEDRO J ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO PEDIATRICO AVE. TITO CASTRO 931 CARR. 14 BO MACHUELO
PONCE PR
00716-4717
US

IV. Provider business mailing address

1639 CALLE MARQUESA URB VALLE REAL
PONCE PR
00716-0502
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-3260
  • Fax:
Mailing address:
  • Phone: 787-643-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5469
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: