Provider Demographics
NPI:1447071022
Name:ORTIZ AVILES, LUIS GUILLERMO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:GUILLERMO
Last Name:ORTIZ AVILES
Suffix:
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:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1557
Mailing Address - Country:US
Mailing Address - Phone:787-241-9487
Mailing Address - Fax:
Practice Address - Street 1:997 CALLE SAN ROBERTO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2759
Practice Address - Country:US
Practice Address - Phone:787-773-6501
Practice Address - Fax:787-773-6544
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program