Provider Demographics
NPI:1053383323
Name:ORTIZ GUEVARA, JUAN R (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:ORTIZ GUEVARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:R
Other - Last Name:ORTIZ GUEVARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,
Mailing Address - Street 1:P.M.B. 2111 P.O.BOX 4956
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-852-3929
Mailing Address - Fax:787-852-3910
Practice Address - Street 1:FONT MARTELO 358 SUITE 204
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-3929
Practice Address - Fax:787-852-3910
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7929207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80352Medicare ID - Type UnspecifiedMEDICARE
PRE79085Medicare UPIN