Provider Demographics
NPI:1992173058
Name:ORTIZ, ERICK (RT)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CALLE LUIS MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-1770
Mailing Address - Country:US
Mailing Address - Phone:787-429-9834
Mailing Address - Fax:
Practice Address - Street 1:ANGEL G MARTINEZ STREET 3
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00637
Practice Address - Country:UM
Practice Address - Phone:787-429-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7142183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7142OtherPROFESIONAL LISENCE