MEDICARE: DR. LORELEI ANNE ORTIZ DMD

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	1223G0001X	General Practice Dentistry	1016	PR

General Provider Information

NPI Number	:	1669479135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORELEI ANNE ORTIZ DMD

Provider Business Mailing Address
First Line	:	BOX 2400 PMB 403
Second Line	:	BOX 2400 PMB 403
City	:	TOA BAJA
State	:	PR
Zip	:	00951-2400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR.863 KM.1.5
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949
Country	:	US
Telephone Number	:	787-521-0921
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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