MEDICARE: DR. GERARDO ORTIZ LOZANO-FISIATRA P.S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	15163	PR

General Provider Information

NPI Number	:	1003960188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GERARDO ORTIZ LOZANO-FISIATRA P.S.C.

Provider Business Mailing Address
First Line	:	29 CALLE NIZA
Second Line	:	PASEO LA BRISAS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5946
Country	:	US
Telephone Number	:	787-638-8415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1789 CARR 21 STE 405
Second Line	:	TORRE DEL METROPOLITANO
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3340
Country	:	US
Telephone Number	:	787-775-2685
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERARDO ORTIZ-LOZANO
Credential	:
Telephone Number	:	787-638-8415

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	02/11/2014

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