Healthcare Provider Details

I. General information

NPI: 1508991076
Provider Name (Legal Business Name): MAYRA LETICIA LLADO ORTEGA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 CALLE RAFAEL LAMAR EXT ROOSEVELT
SAN JUAN PR
00918-2117
US

IV. Provider business mailing address

CALLE RAFAEL LAMAR 374-A EXT ROOSEVELT
HATO REY PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7471
  • Fax: 787-765-9643
Mailing address:
  • Phone: 787-767-7471
  • Fax: 787-765-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2148
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: