Provider Demographics
NPI:1912627795
Name:ORTIZ SAMOT, LYDIA NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:NICOLE
Last Name:ORTIZ SAMOT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 AVE RAMON L RODRIGUEZ APT 1532
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5910
Mailing Address - Country:US
Mailing Address - Phone:787-638-0605
Mailing Address - Fax:
Practice Address - Street 1:BLOQUE 51 #55 CALLE MARGINAL
Practice Address - Street 2:SANTA ROSA LOCAL 1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6837
Practice Address - Country:US
Practice Address - Phone:787-638-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor