=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881720787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JUAN ENRIQUE ORTIZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3H18 CALLE GIRASOL LOMAS VERDES
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00956-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-798-5050
-----------------------------------------------------
Fax | 787-740-3904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E22 CALLE ARGENTINA OASIS GARDENS
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-798-5050
-----------------------------------------------------
Fax | 787-740-3904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 001609
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------