Healthcare Provider Details

I. General information

NPI: 1073035390
Provider Name (Legal Business Name): SORIVETTE SURILLO-ORTIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MUNOZ RIVERA NO 33
YABUCOA PR
00767
US

IV. Provider business mailing address

URB PRADERAS DE NAVARRO CALLE MALAQUITA 239
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 939-237-7989
  • Fax:
Mailing address:
  • Phone: 787-236-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21946
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: