Provider Demographics
NPI:1538362918
Name:ORTIZ LASANTA, GRISELL (MD)
Entity type:Individual
Prefix:DR
First Name:GRISELL
Middle Name:
Last Name:ORTIZ LASANTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 CAMINO LOS AQUINOS
Mailing Address - Street 2:APT 123
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-7901
Mailing Address - Country:US
Mailing Address - Phone:787-722-1248
Mailing Address - Fax:
Practice Address - Street 1:998 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4308
Practice Address - Country:US
Practice Address - Phone:787-722-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine