Healthcare Provider Details

I. General information

NPI: 1902327216
Provider Name (Legal Business Name): MARISARA MORALES ORTIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 5267
CAGUAS PR
00726-5267
US

IV. Provider business mailing address

9195 MORNING RIDGE RD
CORDOVA TN
38016-8493
US

V. Phone/Fax

Practice location:
  • Phone: 787-536-3268
  • Fax:
Mailing address:
  • Phone: 787-536-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number73482
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: