1982662110 NPI number — MRS. ANA LUISA ORTIZ MS, PHL

Table of content: MRS. ANA LUISA ORTIZ MS, PHL (NPI 1982662110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982662110 NPI number — MRS. ANA LUISA ORTIZ MS, PHL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ
Provider First Name:
ANA
Provider Middle Name:
LUISA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, PHL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982662110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3435
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNCOS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00777-2786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-734-6780
Provider Business Mailing Address Fax Number:
787-734-6780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 14 #228 LAS PINAS
Provider Second Line Business Practice Location Address:
JUNCOS
Provider Business Practice Location Address City Name:
JUNCOS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00777-2786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-734-6780
Provider Business Practice Location Address Fax Number:
787-734-6780
Provider Enumeration Date:
05/04/2006

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: 235Z00000X , with the licence number:  579 , 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: 33-02-86-5 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: P 6029 . This is a "CRUZ AZUL P.R." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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