Healthcare Provider Details

I. General information

NPI: 1770038358
Provider Name (Legal Business Name): MISS NEYSSA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 02/28/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CARR 849 APT 329
SAN JUAN PR
00924-4570
US

IV. Provider business mailing address

CENTRO INTERNACIONAL DE MERCADEO TORRE 2 OFICINA 302
GUAYNABO PR
00968
US

V. Phone/Fax

Practice location:
  • Phone: 787-473-0261
  • Fax:
Mailing address:
  • Phone: 787-399-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4319
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4319
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4319
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4319
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4319
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: