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General NPI Number Information
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NPI Number | 1417010943
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Entity Type | Individual
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Provider Name | MAXIMINO RAFAEL ORTEGA MD
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CALLE2 A15 PANORAMA ESTATE CALLE GEORGETTI 61 NARANJITO
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City | BAYAMON
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State | PR
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Zip | 00957-4379
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Country | US
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Telephone | 787-730-5309
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Fax | 787-869-2575
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Provider Business Mailing Address
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Address Line | CALLE2A15 PANORAMA ESTATE
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City | BAYAMON
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State | PR
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Zip | 00957-4379
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Country | US
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Telephone | 787-730-5309
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Fax | 787-869-2575
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5564
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License Number State | PR
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