MEDICARE: PETER JOSEPH ORTIZ M.A.

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	103TC0700X	Clinical Psychologist	465	PR

General Provider Information

NPI Number	:	1093916249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER JOSEPH ORTIZ M.A.

Provider Business Mailing Address
First Line	:	PO BOX 70344
Second Line	:	PMB 343
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-269-6359
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN JUAN MEDICAL CENTER
Second Line	:	RIO PIEDAS STATE PSYQUIATRIC HOSPITAL
City	:	SAN JUAN
State	:	PR
Zip	:	00922-2100
Country	:	US
Telephone Number	:	787-766-4646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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