Healthcare Provider Details

I. General information

NPI: 1437067683
Provider Name (Legal Business Name): GENESIS MICHELLE ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 AVE UNIV INTERAMERICANA
SAN GERMAN PR
00683-3922
US

IV. Provider business mailing address

HC 2 BOX 15003
SAN GERMAN PR
00683-9469
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-3333
  • Fax:
Mailing address:
  • Phone: 939-305-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number9121
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: