MEDICARE: DR. LYDIA NICOLE ORTIZ SAMOT DC

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	111N00000X	Chiropractor	877	PR

General Provider Information

NPI Number	:	1912627795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYDIA NICOLE ORTIZ SAMOT DC

Provider Business Mailing Address
First Line	:	50 AVE RAMON L RODRIGUEZ APT 1532
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959-5910
Country	:	US
Telephone Number	:	787-638-0605
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLOQUE 51 #55 CALLE MARGINAL
Second Line	:	SANTA ROSA LOCAL 1
City	:	BAYAMON
State	:	PR
Zip	:	00959-6837
Country	:	US
Telephone Number	:	787-638-0605
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	09/23/2025

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