=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689747172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YASLIN C ORTIZ DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE. PONCE DE LEON EDIF 1801 PARADA 26 SUITE 405
-----------------------------------------------------
City | SANTURCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-726-0440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | VILLAS MONTE ATENAS 1300 CALLE ATENAS APARTAMENTO 702
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-7811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2753
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------