Healthcare Provider Details

I. General information

NPI: 1306256276
Provider Name (Legal Business Name): CRISTINA ORTIZ-DIAZ DMD, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CARR 2 STE 301
VEGA ALTA PR
00692-6092
US

IV. Provider business mailing address

67 CALLE NOGAL MONTECASINO
TOA ALTA PR
00953-3725
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-6234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberPRV-FP-108-20
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number058198-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3295
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: