Healthcare Provider Details

I. General information

NPI: 1255752960
Provider Name (Legal Business Name): CENTRO VISUAL DR KELVIN ORTIZ PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE MCK JONES
VILLALBA PR
00766-2228
US

IV. Provider business mailing address

PO BOX 1511
VILLALBA PR
00766-1511
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-0091
  • Fax: 787-847-0091
Mailing address:
  • Phone: 787-847-0091
  • Fax: 787-847-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number550
License Number StatePR

VIII. Authorized Official

Name: DR. KELVIN ORTIZ
Title or Position: PRESIDENT
Credential: O.D.
Phone: 787-847-0091