Provider Demographics
NPI:1992582266
Name:ORTIZ COLON, EMMANUEL ALBERTO
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:ALBERTO
Last Name:ORTIZ COLON
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:URB LLANOS DE PROVIDENCIA 515 CALLE ORQUIDEA
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-3187
Mailing Address - Country:US
Mailing Address - Phone:939-217-0415
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA ESTATAL PR #14, INTERIOR, KM 0.3,
Practice Address - Street 2:BARRIO RINCON, SECTOR LOMAS
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-0073
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36930163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program