Provider Demographics
NPI:1316966468
Name:ORTIZ MENDEZ, DIMARY I (MD)
Entity type:Individual
Prefix:
First Name:DIMARY
Middle Name:
Last Name:ORTIZ MENDEZ
Suffix:I
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 1:49 CARR 307 APARTADO 108
Mailing Address - Street 2:EDIFICIOS OLAS A8, CABOQUERON RESORT
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-9768
Mailing Address - Country:US
Mailing Address - Phone:787-249-5062
Mailing Address - Fax:
Practice Address - Street 1:740 AVE. HOSTOS , STE. 311, COND. MEDICAL CENTER PLAZA
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1541
Practice Address - Country:US
Practice Address - Phone:787-249-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN558208D00000X
PR14094208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDD319AOtherPTAN
PRHS203AOtherPTAN
141306000114-001OtherCCN
PRHC69562Medicare UPIN