Provider Demographics
NPI:1902908221
Name:ORTIZ, GERARDO L (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:L
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 CALLE NIZA
Mailing Address - Street 2:PASEO LA BRISAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5946
Mailing Address - Country:US
Mailing Address - Phone:787-638-8415
Mailing Address - Fax:
Practice Address - Street 1:1789 CARR 21 STE 405
Practice Address - Street 2:TORRE DEL METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3340
Practice Address - Country:US
Practice Address - Phone:787-775-2685
Practice Address - Fax:787-277-0362
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15163208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85391AMedicare PIN
PRI-13214Medicare UPIN