Provider Demographics
NPI:1730897190
Name:ORTIZ BURGOS, RUBI DEL MAR (MD)
Entity type:Individual
Prefix:
First Name:RUBI
Middle Name:DEL MAR
Last Name:ORTIZ BURGOS
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1506
Mailing Address - Country:US
Mailing Address - Phone:787-450-3092
Mailing Address - Fax:
Practice Address - Street 1:130 AVE ARTERIAL HOSTOS APT B102
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-5203
Practice Address - Country:US
Practice Address - Phone:787-450-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23671208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice