Provider Demographics
NPI:1356063101
Name:ORTIZ CORDERO, RUBEN GABRIEL
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:GABRIEL
Last Name:ORTIZ CORDERO
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:RR 4 BOX 26145
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9470
Mailing Address - Country:US
Mailing Address - Phone:787-236-7893
Mailing Address - Fax:
Practice Address - Street 1:29 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3705
Practice Address - Country:US
Practice Address - Phone:787-236-7893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program