1053383323 NPI number — DR. JUAN R. ORTIZ GUEVARA M.D.

Table of content: (NPI 1528000866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053383323 NPI number — DR. JUAN R. ORTIZ GUEVARA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ GUEVARA
Provider First Name:
JUAN
Provider Middle Name:
R.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTIZ GUEVARA
Provider Other First Name:
JUAN
Provider Other Middle Name:
R.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D,
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053383323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.M.B. 2111 P.O.BOX 4956
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-852-3929
Provider Business Mailing Address Fax Number:
787-852-3910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FONT MARTELO 358 SUITE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-3929
Provider Business Practice Location Address Fax Number:
787-852-3910
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  7929 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105362400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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