Provider Demographics
NPI:1104082056
Name:ORTIZ-CASTRO, ILIA YAHJAIRA
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:YAHJAIRA
Last Name:ORTIZ-CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 15100
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-8900
Mailing Address - Country:US
Mailing Address - Phone:787-888-4343
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 15100
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-8900
Practice Address - Country:US
Practice Address - Phone:787-888-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17195208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice