Provider Demographics
NPI:1124070537
Name:ORTIZ - GOMEZ, ADELAIDA T (MD)
Entity type:Individual
Prefix:DR
First Name:ADELAIDA
Middle Name:T
Last Name:ORTIZ - GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 NORTH COAST VILLAGE
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-915-5247
Mailing Address - Fax:
Practice Address - Street 1:CLINICA DE LA ESCUELA DE MEDICINA
Practice Address - Street 2:SHOPPING REPARTO, AVE. AMERICO MIRANDA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021028Medicare PIN
PRH83930Medicare UPIN