Provider Demographics
NPI:1447466230
Name:NIEVES ORTEGA, JORGE O
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:O
Last Name:NIEVES ORTEGA
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:CALLE TRINITARIA # 132
Mailing Address - Street 2:URB.JARDINES DE NARANJITO
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719
Mailing Address - Country:US
Mailing Address - Phone:787-869-0305
Mailing Address - Fax:
Practice Address - Street 1:132 CALLE TRINITARIA
Practice Address - Street 2:URB.JARDINES DE NARANJITO
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-4418
Practice Address - Country:US
Practice Address - Phone:787-869-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1297P146L00000X
PR3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57511Medicare PIN