Healthcare Provider Details

I. General information

NPI: 1023765948
Provider Name (Legal Business Name): ODALYS ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12159 SW 137TH TER
MIAMI FL
33186-6045
US

IV. Provider business mailing address

12159 SW 137TH TER
MIAMI FL
33186-6045
US

V. Phone/Fax

Practice location:
  • Phone: 305-548-9766
  • Fax:
Mailing address:
  • Phone: 305-548-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28691
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB427293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: