Healthcare Provider Details

I. General information

NPI: 1164379111
Provider Name (Legal Business Name): MJOM ENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 CARR 21 STE 202
SAN JUAN PR
00921-3335
US

IV. Provider business mailing address

1789 CARR 21 STE 202
SAN JUAN PR
00921-3335
US

V. Phone/Fax

Practice location:
  • Phone: 787-679-6513
  • Fax:
Mailing address:
  • Phone: 787-679-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIANA J ORTIZ MARTINEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-679-6513