Healthcare Provider Details

I. General information

NPI: 1700769783
Provider Name (Legal Business Name): JAED MARIE ORTIZ RODRIGUEZ M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 7504
GUAYANILLA PR
00656-9408
US

IV. Provider business mailing address

HC 1 BOX 7504
GUAYANILLA PR
00656-9408
US

V. Phone/Fax

Practice location:
  • Phone: 787-615-5672
  • Fax:
Mailing address:
  • Phone: 787-615-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number7405
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: