Provider Demographics
NPI:1801454681
Name:HERRERA ORTIZ, JOSE CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CARLOS
Last Name:HERRERA ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:CARLOS
Other - Last Name:HERRERA ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:264 CALLE FORDHAM
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4115
Mailing Address - Country:US
Mailing Address - Phone:787-427-4541
Mailing Address - Fax:
Practice Address - Street 1:264 CALLE FORDHAM
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4115
Practice Address - Country:US
Practice Address - Phone:787-427-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22136208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice