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General NPI Number Information
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NPI Number | 1255605168
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Entity Type | Individual
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Provider Name | BETHZAIDA ORENGO DOCTORATE IN CLINICA
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Gender | Female
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | FAGOT AVENUE #3260
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City | PONCE
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State | PR
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Zip | 00730
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Country | US
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Telephone | 787-385-9752
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Fax | 787-841-6747
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Provider Business Mailing Address
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Address Line | P.O. BOX 560673
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City | GUAYANILLA
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State | PR
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Zip | 00656
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Country | US
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Telephone | 787-835-5394
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Fax | 787-841-6747
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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 | 2573
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License Number State | PR
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