Healthcare Provider Details

I. General information

NPI: 1326037359
Provider Name (Legal Business Name): JORGE L ORTIZ RAMOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 863 KM 0.5 BO PAJAROS CANDELARIO
TOA BAJA PR
00949
US

IV. Provider business mailing address

PMB 213 PO BOX 2400
TOD BAJA PR
00951
US

V. Phone/Fax

Practice location:
  • Phone: 787-251-2667
  • Fax: 787-251-1418
Mailing address:
  • Phone: 787-251-2667
  • Fax: 787-251-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10106
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: