Healthcare Provider Details

I. General information

NPI: 1568246569
Provider Name (Legal Business Name): DR JUAN A COMAS ORTIZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 363 KM 0.1 REPARTO SANTA ANA
SABANA GRANDE PR
00637
US

IV. Provider business mailing address

PO BOX 1235
SABANA GRANDE PR
00637-1235
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-3786
  • Fax:
Mailing address:
  • Phone: 787-400-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUAN A COMAS ORTIZ
Title or Position: PRESIDENT/TREASURE
Credential: MD
Phone: 787-400-3786