Healthcare Provider Details

I. General information

NPI: 1164326849
Provider Name (Legal Business Name): XIARA MARTINEZ ORTIZ CPL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ISLA VERDE MALL - 187 CALLE DALIA ST. 205B
CAROLINA PR
00979
US

IV. Provider business mailing address

CALLE BONITO 533 URB. CIUDAD INTERAMERICA
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-394-0877
  • Fax:
Mailing address:
  • Phone: 787-394-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4820
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: