Healthcare Provider Details

I. General information

NPI: 1912820333
Provider Name (Legal Business Name): GRETCHEN TERESA ORTIZ OTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. BAIROA, CARR. 173, R 795 KM0.3
AGUAS BUENAS PR
00703
US

IV. Provider business mailing address

HC 4 BOX 8469
AGUAS BUENAS PR
00703-8869
US

V. Phone/Fax

Practice location:
  • Phone: 939-246-8276
  • Fax:
Mailing address:
  • Phone: 939-246-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number006252
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: