Healthcare Provider Details

I. General information

NPI: 1245497684
Provider Name (Legal Business Name): MRS. BRENDA ORTIZ OLIVERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF LAS VEGAS 420 BO CAMPO ALEGRE
MANATI PR
00674
US

IV. Provider business mailing address

URB. SAN AGUSTIN 92 CALLE SAN BERNARDO
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-1426
  • Fax: 787-884-3757
Mailing address:
  • Phone: 787-854-1426
  • Fax: 787-884-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number527
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: