MEDICARE: ROSE STEPHANIE ORTIZ DAVILA MA, LCDA.

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	103TC1900X	Counseling Psychologist	8481	PR

General Provider Information

NPI Number	:	1881585958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE STEPHANIE ORTIZ DAVILA MA, LCDA.

Provider Business Mailing Address
First Line	:	12 CALLE ANGEL L ORTIZ # A-12
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-2657
Country	:	US
Telephone Number	:	787-373-1062
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB. PARADIS CALLE ANGEL L ORTIZ # A-12
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-6461
Country	:	US
Telephone Number	:	787-373-1062
Fax Number	:

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

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	12/23/2025

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