Healthcare Provider Details

I. General information

NPI: 1760406631
Provider Name (Legal Business Name): HERIBERTO MAXIMO ORTIZ PSY.D. , C.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/25/2013
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 TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6187
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: