Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 18276 | PR |
NPI | 1043508237 |
---|---|
Provider Name | Dr. Ed Joel Ortega Cortes |
First Address | Moca, PR 00676-0215 |
Second Address | Moca, PR 00676-4153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 02/03/2017 |