Provider Demographics
NPI:1699736082
Name:ORTIZ-CLAS, WILFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:ORTIZ-CLAS
Suffix:
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:A9 CALLE ARROYO
Mailing Address - Street 2:URB. EL REMANSO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6101
Mailing Address - Country:US
Mailing Address - Phone:787-720-1133
Mailing Address - Fax:
Practice Address - Street 1:1396 CALLE SAN RAFAEL
Practice Address - Street 2:MEDICAL PAVILLION - SUITE - 15
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2526
Practice Address - Country:US
Practice Address - Phone:787-721-6560
Practice Address - Fax:787-721-1622
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4134208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-5099Medicare ID - Type Unspecified
PRC-77-296Medicare UPIN