Healthcare Provider Details

I. General information

NPI: 1386508141
Provider Name (Legal Business Name): PAOLA NICOLE ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALLE EL PARAISO
AIBONITO PR
00705-9632
US

IV. Provider business mailing address

15 CALLE EL PARAISO
AIBONITO PR
00705-9632
US

V. Phone/Fax

Practice location:
  • Phone: 939-252-1505
  • Fax:
Mailing address:
  • Phone: 939-252-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8812
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: