Healthcare Provider Details

I. General information

NPI: 1255495412
Provider Name (Legal Business Name): INGRID LETICIA CASAS DOLZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO SALUD MENTAL, SAN JUAN BAUTISTA MEDICAL CENTER CALL BOX 4964
CAGUAS PR
00726-4964
US

IV. Provider business mailing address

1400 N SEMORAN BLVD
ORLANDO FL
32807-3536
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-0550
  • Fax: 787-653-0525
Mailing address:
  • Phone: 407-823-8421
  • Fax: 407-482-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14873
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number14873
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberACN945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: