Healthcare Provider Details

I. General information

NPI: 1992683957
Provider Name (Legal Business Name): MISS LAURYANN MARIE RODRIGUEZ ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2538
US

IV. Provider business mailing address

HC 2 BOX 8695
COROZAL PR
00783-6118
US

V. Phone/Fax

Practice location:
  • Phone: 787-303-9662
  • Fax:
Mailing address:
  • Phone: 787-407-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6551-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: