Provider Demographics
NPI:1295098507
Name:ORTIZ PEDROGO, ROSARIO (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:ROSARIO
Middle Name:
Last Name:ORTIZ PEDROGO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TITI CASTRO AVENUE 14 SUITE 102
Mailing Address - Street 2:HOSPITAL SAN LUCAS 2
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-0000
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:787-750-2830
Practice Address - Street 1:TITO CASTRO AVENUE 14 SUITE 102
Practice Address - Street 2:HOSPITAL SAN LUCAS 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731-0000
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-750-2830
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012619163W00000X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR012619OtherLICENSE