Healthcare Provider Details

I. General information

NPI: 1629543988
Provider Name (Legal Business Name): AGNES EUNICE ROSARIO ORTIZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE GUILLERMO ESTEVES, NUMERO 49
JAYUYA PR
00664
US

IV. Provider business mailing address

PO BOX 1003
CASTANER PR
00631-1003
US

V. Phone/Fax

Practice location:
  • Phone: 787-705-3850
  • Fax:
Mailing address:
  • Phone: 787-221-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8560
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: