Provider Demographics
NPI:1720962939
Name:ORTIZ, ADARA CAROLINA (PA)
Entity type:Individual
Prefix:
First Name:ADARA
Middle Name:CAROLINA
Last Name:ORTIZ
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 1:184A CALLE SEGUNDA
Mailing Address - Street 2:BO. COQUI
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704
Mailing Address - Country:US
Mailing Address - Phone:787-677-3079
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 51431
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00950-1431
Practice Address - Country:US
Practice Address - Phone:787-523-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001258363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty