Provider Demographics
NPI:1154905693
Name:JOHANNY ORTIZ LOPEZ PSC
Entity type:Organization
Organization Name:JOHANNY ORTIZ LOPEZ PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-602-0252
Mailing Address - Street 1:PR 3 KM 158.5 URB. MINIMA LA CARMEN
Mailing Address - Street 2:229 SUITE B
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-2319
Mailing Address - Country:US
Mailing Address - Phone:787-824-4333
Mailing Address - Fax:787-824-4333
Practice Address - Street 1:PR 3 KM 158.5 URB. MINIMA LA CARMEN
Practice Address - Street 2:229 SUITE B
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2319
Practice Address - Country:US
Practice Address - Phone:787-824-4333
Practice Address - Fax:787-824-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory