Basic Information
| Provider Information | |||||||||
| NPI: | 1124070537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ - GOMEZ | ||||||||
| FirstName: | ADELAIDA | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 NORTH COAST VILLAGE | ||||||||
| Address2: | |||||||||
| City: | VEGA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879155247 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CLINICA DE LA ESCUELA DE MEDICINA | ||||||||
| Address2: | SHOPPING REPARTO, AVE. AMERICO MIRANDA | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877587910 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 13400 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.