MEDICARE: DR. PABLO ANTONIO ORTIZCEREZO MD

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	174400000X	Specialist	6847	PR

General Provider Information

NPI Number	:	1770550048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PABLO ANTONIO ORTIZCEREZO MD

Provider Business Mailing Address
First Line	:	PO BOX 21078
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-1078
Country	:	US
Telephone Number	:	787-758-0555
Fax Number	:	787-761-0944

Provider Business Practice Location Address
First Line	:	112 CALLE ARZUAGA
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00925-3321
Country	:	US
Telephone Number	:	787-763-2939
Fax Number	:	787-761-0944

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

Provider Enumeration Date	:	03/04/2006
Last Update Date	:	07/08/2007

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