Healthcare Provider Details

I. General information

NPI: 1821889791
Provider Name (Legal Business Name): LIZ MASSIEL ALVAREZ ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 CATALINA ST
TITUSVILLE FL
32796-2211
US

IV. Provider business mailing address

3880 CATALINA ST
TITUSVILLE FL
32796-2211
US

V. Phone/Fax

Practice location:
  • Phone: 321-346-8450
  • Fax: 321-249-1105
Mailing address:
  • Phone: 321-346-8450
  • Fax: 321-249-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-434967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: