Healthcare Provider Details

I. General information

NPI: 1659456168
Provider Name (Legal Business Name): OMAR NIEVES ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/26/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO CARDIOVASCULAR DE PUERTO RICO Y DEL CARIBE AVE AMERICO MIRANDA CENTRO MEDICO SUITE 8B
SAN JUAN PR
00936
US

IV. Provider business mailing address

URB. LOS PASEOS ALTO 35 CALLE 2
SAN JUAN PR
00926-5917
US

V. Phone/Fax

Practice location:
  • Phone: 787-771-3030
  • Fax: 888-378-0294
Mailing address:
  • Phone: 787-378-4718
  • Fax: 888-378-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16079
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number16079
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16079
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: