Healthcare Provider Details

I. General information

NPI: 1801668306
Provider Name (Legal Business Name): NICOLE E ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB BARALT I 20
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 193069
SAN JUAN PR
00919-3069
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-4233
  • Fax: 787-494-2072
Mailing address:
  • Phone: 787-761-0036
  • Fax: 787-494-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4768-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: