Healthcare Provider Details

I. General information

NPI: 1881585958
Provider Name (Legal Business Name): ROSE STEPHANIE ORTIZ DAVILA MA, LCDA.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. PARADIS CALLE ANGEL L ORTIZ # A-12
CAGUAS PR
00725-6461
US

IV. Provider business mailing address

12 CALLE ANGEL L ORTIZ # A-12
CAGUAS PR
00725-2657
US

V. Phone/Fax

Practice location:
  • Phone: 787-373-1062
  • Fax:
Mailing address:
  • Phone: 787-373-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8481
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: