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General NPI Number Information
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NPI Number | 1023212230
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Entity Type | Individual
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Provider Name | JOSE ANTONIO ORTIZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 435 AVE HOSTOS
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City | SAN JUAN
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State | PR
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Zip | 00918-3014
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Country | US
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Telephone | 787-753-9515
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Fax | 787-753-8327
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Provider Business Mailing Address
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Address Line | 1362 AVE MAGDALENA CONDOMINIO PLAZA STELLA APT. 1203
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City | SAN JUAN
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State | PR
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Zip | 00907-2029
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Country | US
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Telephone | 787-667-9507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 15377
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License Number State | PR
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