Healthcare Provider Details

I. General information

NPI: 1376201608
Provider Name (Legal Business Name): MILAGROS COLON ORTIZ PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E22 CAMINO DE BEGONIAS URB. ENRAMADA
BAYAMON PR
00961
US

IV. Provider business mailing address

E22 CAMINO DE BEGONIAS URB. ENRAMADA
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-604-7435
  • Fax:
Mailing address:
  • Phone: 787-604-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4787
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: