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General NPI Number Information
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NPI Number | 1700295318
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Entity Type | Organization
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Legal Business Name | MARIA DE LOURDES ORTIZ, CSP
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 86 VIA MIRADERO HACIENDA SAN JOSE
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City | CAGUAS
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State | PR
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Zip | 00727-3007
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Country | US
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Telephone | 787-745-0806
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Fax | 787-745-0806
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Provider Business Mailing Address
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Address Line | 86 VIA MIRADERO HACIENDA SAN JOSE
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City | CAGUAS
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State | PR
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Zip | 00727-3007
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Country | US
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Telephone | 787-745-0806
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Fax | 787-745-0806
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA DE LOURDES ORTIZ-ROSARIO
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Credential | M.D.
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Telephone | 787-630-7923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 13806
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License Number State | PR
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