Healthcare Provider Details

I. General information

NPI: 1932240330
Provider Name (Legal Business Name): LENNYS M BRAVO ORTIZ PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 04/28/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132-13 AVE. ROBERTO CLEMENTE URB. VILLA CAROLINA
CAROLINA PR
00985-4124
US

IV. Provider business mailing address

CIUDAD JARDIN 82 CALLE GARDENIA
CAROLINA PR
00987-2206
US

V. Phone/Fax

Practice location:
  • Phone: 787-710-1343
  • Fax:
Mailing address:
  • Phone: 787-710-1343
  • Fax: 787-710-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1888
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: