Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21217 | PR |
NPI | 1023573540 |
---|---|
Provider Name | Angel Miguel Ortiz Ortega |
First Address | Caguas, PR 00726-6032 |
Second Address | Humacao, PR 00791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2019 |
Last Update Date | 08/02/2019 |