Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21320 | PR |
NPI | 1043726920 |
---|---|
Provider Name | Dr. Melissa Ortiz Pena |
First Address | Caguas, PR 00725 |
Second Address | Caguas, PR 00727-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2017 |
Last Update Date | 24/05/2019 |