MEDICARE: ANGEL ORTIZ PA

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1336861004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL ORTIZ PA

Provider Business Mailing Address
First Line	:	IF21 CALLE CRUZ DE MALTA
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-3107
Country	:	US
Telephone Number	:	787-478-0998
Fax Number	:

Provider Business Practice Location Address
First Line	:	TORRE AUXILIO MUTUO SUITE #715
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-0091
Country	:	US
Telephone Number	:	787-250-0124
Fax Number	:

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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