Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 14259 | PR |
NPI | 1154377398 |
---|---|
Provider Name | Dr. Bethzaida Ortiz-Cruz |
First Address | Coamo, PR 00769-9744 |
Second Address | Ponce, PR 00716-2348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I-04521 | (02) | PR |