Healthcare Provider Details

I. General information

NPI: 1649201567
Provider Name (Legal Business Name): AIDA LUZ ORTIZ- MARTINEZ PH.D; PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AIDA LUZ ORTIZ-MARTINEZ PH.D.; PSY.D.

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE MIGUEL CASILLAS
HUMACAO PR
00791-3638
US

IV. Provider business mailing address

PO BOX 9121
HUMACAO PR
00792-9121
US

V. Phone/Fax

Practice location:
  • Phone: 787-850-9093
  • Fax: 787-850-9094
Mailing address:
  • Phone: 787-850-9093
  • Fax: 787-850-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1574
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1574
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: