Provider Demographics
NPI:1114719622
Name:ORTIZ MUNOZ, EDWIN GABRIEL
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:GABRIEL
Last Name:ORTIZ MUNOZ
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 1:1122 CALLE 54 SE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2749
Mailing Address - Country:US
Mailing Address - Phone:787-460-6241
Mailing Address - Fax:
Practice Address - Street 1:1122 CALLE 54 SE APT 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2749
Practice Address - Country:US
Practice Address - Phone:787-460-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program