Provider Demographics
NPI:1053718650
Name:ORTIZ, DARIANA
Entity type:Individual
Prefix:
First Name:DARIANA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CALLE CALANDRIA
Mailing Address - Street 2:URB HACIENDA EL PILAR
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:#7788 CARRETERA #167 AVENIDA LAS CUMBRES
Practice Address - Street 2:FARMACIA KMAR PLAZA MAYOR
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-0000
Practice Address - Country:US
Practice Address - Phone:787-730-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist