Healthcare Provider Details

I. General information

NPI: 1750857553
Provider Name (Legal Business Name): YARITZA PEREZ ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CALLE MARGINAL URB VALENCIA 1
JUNCOS PR
00777-0077
US

IV. Provider business mailing address

PO BOX 2369
JUNCOS PR
00777-2369
US

V. Phone/Fax

Practice location:
  • Phone: 787-679-6569
  • Fax: 787-734-1633
Mailing address:
  • Phone: 787-462-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5069
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier06006610012
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: