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General NPI Number Information
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NPI Number | 1649525874
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Entity Type | Organization
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Legal Business Name | PROSPERITUS PSC
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 400 CARR 176 APT 605
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City | SAN JUAN
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State | PR
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Zip | 00926-6680
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Country | US
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Telephone | 787-529-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CARR 176 APT 605
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City | SAN JUAN
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State | PR
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Zip | 00926-6680
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Country | US
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Telephone | 787-529-1699
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HIRAM D ORTEGA
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Credential | M.D
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Telephone | 787-529-1699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 17586
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2903
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License Number State | PR
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