Provider Demographics
NPI:1386727121
Name:ORTIZ SANTIAGO, ADA N (MD)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:N
Last Name:ORTIZ SANTIAGO
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:STREET1D21 ALTOS LA FUENTE
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-258-3076
Mailing Address - Fax:
Practice Address - Street 1:AVENUE MUNOZ MARIN
Practice Address - Street 2:HIMA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-2115
Practice Address - Fax:787-744-3900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics