Provider Demographics
NPI:1568441574
Name:GUZMAN-ORTIZ, IVAN SR (MD)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:GUZMAN-ORTIZ
Suffix:SR
Gender:M
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:PO BOX 1122
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1122
Mailing Address - Country:US
Mailing Address - Phone:787-405-6021
Mailing Address - Fax:
Practice Address - Street 1:EDIF PROF HOSPITAL MENONITA
Practice Address - Street 2:SUITE 210
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-1001
Practice Address - Fax:787-263-7978
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12604207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C84364Medicare UPIN
89270Medicare ID - Type Unspecified