Basic Information
Provider Information | |||||||||
NPI: | 1205083151 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ORTIZ - GONZALEZ | ||||||||
FirstName: | LUIS | ||||||||
MiddleName: | E. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | ANESTESIOLOGIA RCM | ||||||||
Address2: | EDIF. PRINCIPAL RCM PISO9 OFIC. 983 CENTRO MEDICO DE PR | ||||||||
City: | RIO PIEDRAS | ||||||||
State: | PR | ||||||||
PostalCode: | 009352116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877580640 | ||||||||
FaxNumber: | 7877581327 | ||||||||
Practice Location | |||||||||
Address1: | ANESTESIOLOGIA RCM | ||||||||
Address2: | CENTRO MEDICO DE PUERTO RICO, BO. MONACILLOS | ||||||||
City: | RIO PIEDRAS | ||||||||
State: | PR | ||||||||
PostalCode: | 009352116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877580640 | ||||||||
FaxNumber: | 7877581327 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/22/2008 | ||||||||
LastUpdateDate: | 09/19/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 18368 | PR | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.