MEDICARE: MJOM ENT LLC

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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1164379111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJOM ENT LLC

Provider Business Mailing Address
First Line	:	1789 CARR 21 STE 202
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3335
Country	:	US
Telephone Number	:	787-679-6513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1789 CARR 21 STE 202
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3335
Country	:	US
Telephone Number	:	787-679-6513
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIANA J ORTIZ MARTINEZ
Credential	:	MD
Telephone Number	:	787-679-6513

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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