Healthcare Provider Details

I. General information

NPI: 1669810933
Provider Name (Legal Business Name): HERIBERTO M. ORTIZ, PSY.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 N KENDALL DR SUITE 415
MIAMI FL
33156-7564
US

IV. Provider business mailing address

7700 N KENDALL DR SUITE 415
MIAMI FL
33156-7564
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-2403
  • Fax: 305-274-2433
Mailing address:
  • Phone: 305-274-2403
  • Fax: 305-274-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6187
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number549
License Number StateFL

VIII. Authorized Official

Name: HERIBERTO M ORTIZ
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 305-274-2403