Provider Demographics
NPI:1750434106
Name:ORTIZ-LARA, PEDRO (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:ORTIZ-LARA
Suffix:
Gender:M
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 399
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-0399
Mailing Address - Country:US
Mailing Address - Phone:787-824-7058
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE SEGUNDO DIAZ
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3329
Practice Address - Country:US
Practice Address - Phone:787-824-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11257208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG02722Medicare UPIN
PR0090134Medicare ID - Type UnspecifiedMEDICARE-PROVIDER