Healthcare Provider Details

I. General information

NPI: 1407767148
Provider Name (Legal Business Name): ANTHONY MASSOL ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EXT. SANTA TERESITA 4130 CALLE SANTA CATALINA
PONCE PR
00730
US

IV. Provider business mailing address

EXT. SANTA TERESITA 4130 CALLE SANTA CATALINA
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-219-7484
  • Fax:
Mailing address:
  • Phone: 787-219-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15929
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15929
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: