Provider Demographics
NPI:1992315303
Name:ORTIZ, JESUS ORLANDO
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ORLANDO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 VIA SOL
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-3061
Mailing Address - Country:US
Mailing Address - Phone:787-479-8673
Mailing Address - Fax:
Practice Address - Street 1:424 VIA SOL
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-3061
Practice Address - Country:US
Practice Address - Phone:787-479-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2574183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician