Healthcare Provider Details

I. General information

NPI: 1891742193
Provider Name (Legal Business Name): JUAN D. ORTIZ RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CALLE MONSERRATE
SALINAS PR
00751-3382
US

IV. Provider business mailing address

URB. PARQUE INTERAMERICANA #66
GUAYAMA PR
00784
US

V. Phone/Fax

Practice location:
  • Phone: 787-824-5910
  • Fax:
Mailing address:
  • Phone: 787-824-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11176
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: