Healthcare Provider Details

I. General information

NPI: 1427978352
Provider Name (Legal Business Name): JUAN ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 AV. MANUEL FERNANDEZ JUNCOS SUITE 2A
SAN JUAN PR
00909
US

IV. Provider business mailing address

1413 AV. MANUEL FERNANDEZ JUNCOS SUITE 2A
SAN JUAN PR
00909
US

V. Phone/Fax

Practice location:
  • Phone: 787-922-7977
  • Fax:
Mailing address:
  • Phone: 787-922-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number009119
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: