Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 4695 | PR |
NPI | 1275527780 |
---|---|
Provider Name | Victor N. Ortiz - Justiniano |
First Address | San Juan, PR 00927-6370 |
Second Address | Bayamon, PR 00960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 27/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2-5547 | SSS (01) |