Healthcare Provider Details

I. General information

NPI: 1649879305
Provider Name (Legal Business Name): MELISSA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15451 KIPPFORD CT
MIAMI LAKES FL
33014-8003
US

IV. Provider business mailing address

15451 KIPPFORD CT
MIAMI LAKES FL
33014-8003
US

V. Phone/Fax

Practice location:
  • Phone: 786-503-9177
  • Fax:
Mailing address:
  • Phone: 786-503-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: