MEDICARE: LORTIZ CARDIOVASCULAR MEDICINE PSC

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	261Q00000X	Clinic/Center	14849	PR

General Provider Information

NPI Number	:	1801107073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORTIZ CARDIOVASCULAR MEDICINE PSC

Provider Business Mailing Address
First Line	:	COND COLINA REAL APT 1101
Second Line	:	FELIZA GAUTIER
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-798-6550
Fax Number	:	787-798-6590

Provider Business Practice Location Address
First Line	:	COND CORAL INN APT 1101
Second Line	:	FELIZA GAUTIER
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1454
Country	:	US
Telephone Number	:	787-798-6550
Fax Number	:	787-798-6590

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUIS ORTIZ
Credential	:	MD
Telephone Number	:	787-795-6550

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/23/2010

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