Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 8154 | PR |
NPI | 1013920164 |
---|---|
Provider Name | Dr. Jorge L Ortiz Melendez |
First Address | Toa Baja, PR 00950-1513 |
Second Address | Bayamon, PR 00959-8051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 20/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F-43989 | (02) | PR |