Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 9468 | PR |
NPI | 1053390732 |
---|---|
Provider Name | Luis J Ortiz-Espinosa |
First Address | Bayamon, PR 00961 |
Second Address | Carolina, PR 00983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 11/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
81923 | TRIPLE-S (01) | PR |
F07639 | (02) | PR |