1861090177 NPI number — CLINICA MEDICINA PRIMARIA Y PREVENTIVA - DR ANGEL M ORTIZ ORTEGA LLC

Table of content: (NPI 1861090177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861090177 NPI number — CLINICA MEDICINA PRIMARIA Y PREVENTIVA - DR ANGEL M ORTIZ ORTEGA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA MEDICINA PRIMARIA Y PREVENTIVA - DR ANGEL M ORTIZ ORTEGA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Middle Name:
Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1861090177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6032
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:
00726-6032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-421-4068
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 183 KM 4.8
Provider Second Line Business Practice Location Address:
BO TOMAS DE CASTRO 2
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-239-9333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ ORTEGA
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
MIGUEL
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-259-9333

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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