Provider Demographics
NPI:1962413575
Name:ORTIZ, BRENDA IVELISSE (RPH)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:IVELISSE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RPH
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 14
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-0014
Mailing Address - Country:US
Mailing Address - Phone:787-867-2137
Mailing Address - Fax:
Practice Address - Street 1:AVE.LUIS MUNOZ MARIN
Practice Address - Street 2:DESVIO
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-6010
Practice Address - Fax:787-867-6008
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist