MEDICARE: MARIMAR ORTIZ GOMEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	8482	PR

General Provider Information

NPI Number	:	1841166022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIMAR ORTIZ GOMEZ

Provider Business Mailing Address
First Line	:	200 CALLE MENDEZ VIGO E
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4652
Country	:	US
Telephone Number	:	787-831-1632
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 CALLE MENDEZ VIGO E
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4652
Country	:	US
Telephone Number	:	787-831-1632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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Directions to “ MARIMAR ORTIZ GOMEZ ” Practice Location

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