Provider Demographics
NPI:1053386490
Name:ORTIZ TORO, LYNNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:
Last Name:ORTIZ TORO
Suffix:
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:PO BOX 1331
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1331
Mailing Address - Country:US
Mailing Address - Phone:787-255-2567
Mailing Address - Fax:787-255-2567
Practice Address - Street 1:CARR 308 KM 0.2 # 30
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-1331
Practice Address - Country:US
Practice Address - Phone:787-255-2567
Practice Address - Fax:787-255-2567
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83252Medicare ID - Type Unspecified
PRF50472Medicare UPIN