Provider Demographics
NPI:1447088901
Name:ORTIZ MARTINEZ, GLORIANNE YELLIE (PA)
Entity type:Individual
Prefix:
First Name:GLORIANNE
Middle Name:YELLIE
Last Name:ORTIZ MARTINEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 57478
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-9608
Mailing Address - Country:US
Mailing Address - Phone:787-223-9700
Mailing Address - Fax:
Practice Address - Street 1:HC 5 BOX 57478
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-9608
Practice Address - Country:US
Practice Address - Phone:787-223-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant