Provider Demographics
NPI:1992889802
Name:ORTIZ - LLAVONA, ERIC E (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
Last Name:ORTIZ - LLAVONA
Suffix:
Gender:M
Credentials:MD
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 5255
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-5255
Mailing Address - Country:US
Mailing Address - Phone:787-882-4287
Mailing Address - Fax:787-891-3451
Practice Address - Street 1:EDIFICIO LORAINE
Practice Address - Street 2:CARR #2 KM 123 BO CORRALES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-4287
Practice Address - Fax:787-891-3451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8498207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFL224AOtherMEDICARE PTAN
PRFL224AOtherMEDICARE PTAN