Provider Demographics
NPI:1043067622
Name:ORTIZ, CARLOS R JR
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 33751
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-9043
Mailing Address - Country:US
Mailing Address - Phone:978-407-2813
Mailing Address - Fax:
Practice Address - Street 1:2 CARR 140
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2261
Practice Address - Country:US
Practice Address - Phone:787-846-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist