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General NPI Number Information
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NPI Number | 1164737474
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Entity Type | Individual
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Provider Name | DR. CARLA J ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 3919 ISLA VERDE AVENUE COND. REEF APT 3-FTOWER
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City | CAROLINA
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State | PR
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Zip | 00979-6716
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Country | US
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Telephone | 787-216-3156
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Fax |
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Provider Business Mailing Address
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Address Line | 132-13 VILLA CAROLINA AVE. ROBERTO CLEMENTE
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City | CAROLINA
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State | PR
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Zip | 00985-7329
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Country | US
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Telephone | 787-216-3156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0005221
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License Number State | PR
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