MEDICARE: JOSE DAVID ORTIZ-ROSARIO M.D.

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	207RN0300X	Nephrology Physician	18163	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP096A	OTHER	PR	MEDICARE PTAN

General Provider Information

NPI Number	:	1629221940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE DAVID ORTIZ-ROSARIO M.D.

Provider Business Mailing Address
First Line	:	A8 VIA HORIZONTE
Second Line	:	URB LA VISTA
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4461
Country	:	US
Telephone Number	:	787-886-3254
Fax Number	:	787-957-1555

Provider Business Practice Location Address
First Line	:	B1 CALLE 1 ALTOS FARMACIA MEDINA #2
Second Line	:	VILLAS DE LOIZA
City	:	CANOVANAS
State	:	PR
Zip	:	00729-4116
Country	:	US
Telephone Number	:	787-886-3254
Fax Number	:	787-957-1555

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

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	03/05/2026

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