Healthcare Provider Details

I. General information

NPI: 1710592860
Provider Name (Legal Business Name): YARLEENE ORTIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 863 KM 1.0 BO. CANDELARIA
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 967
BAYAMON PR
00960-0967
US

V. Phone/Fax

Practice location:
  • Phone: 939-336-8000
  • Fax:
Mailing address:
  • Phone: 939-336-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22571
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: