=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083119036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN GABRIEL ORTIZ PHARMD.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2018
-----------------------------------------------------
Last Update Date | 03/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 228 CALLE COLON
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-868-2135
-----------------------------------------------------
Fax | 787-868-2933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 CALLE COLON
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-868-2135
-----------------------------------------------------
Fax | 787-868-2933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 6515
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------