Healthcare Provider Details

I. General information

NPI: 1073780649
Provider Name (Legal Business Name): ZORAIDA FONTAIN ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 CALLE EIDER COUNTRY CLUB
SAN JUAN PR
00924-2335
US

IV. Provider business mailing address

969 CALLE EIDER COUNTRY CLUB
SAN JUAN PR
00924-2335
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1305
  • Fax:
Mailing address:
  • Phone: 787-757-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number3018
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: