Healthcare Provider Details

I. General information

NPI: 1063344497
Provider Name (Legal Business Name): OMAYRA MARISOL ORTIZ ALICEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSIDAD DE PUERTO RICO,RECINTO DE CIENCIAS MEDICAS PASEO DR. JOSE CELSO BARBOSA
SAN JUAN PR
00921
US

IV. Provider business mailing address

URB. CONDADO MODERNO CALLE 1 E12
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 786-521-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number99881
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: