Healthcare Provider Details

I. General information

NPI: 1154468239
Provider Name (Legal Business Name): JORGE V. ORTEGA - GIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AMERICO MIRANDA, ESQ CENTRO MEDICO, PRIMER PISO CENTRO CARDIOVASCULAR DEPR Y DELCARIBE STE 4
RIO PIEDRAS PR
00936-6528
US

IV. Provider business mailing address

1674 CALLE VERBENA URB. SAN FRANCISCO
RIO PIEDRAS PR
00927-6231
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8500
  • Fax: 787-274-8156
Mailing address:
  • Phone: 787-754-8500
  • Fax: 787-274-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3964
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: