Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 009602 | PR |
NPI | 1003808171 |
---|---|
Provider Name | Dr. Jaime Luis Ortiz |
First Address | Juana Diaz, PR 00795-1435 |
Second Address | Coto Laurel, PR 00780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E01284 | (02) | PR |