Basic Information
| Provider Information | |||||||||
| NPI: | 1023212230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1362 AVE MAGDALENA | ||||||||
| Address2: | CONDOMINIO PLAZA STELLA APT. 1203 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009072029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876679507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 AVE HOSTOS | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009183014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877539515 | ||||||||
| FaxNumber: | 7877538327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 15377 | PR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.