Provider Demographics
NPI:1902954142
Name:ORTIZ-SANABRIA, EDNA G (MD)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:G
Last Name:ORTIZ-SANABRIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1645 CALLE TAMESIS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2949
Mailing Address - Country:US
Mailing Address - Phone:787-765-1801
Mailing Address - Fax:787-763-1165
Practice Address - Street 1:45 CALLE DIEGO VEGA
Practice Address - Street 2:AMELIA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965-5311
Practice Address - Country:US
Practice Address - Phone:787-783-4479
Practice Address - Fax:787-783-0059
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR9589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89477OtherSSS