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General NPI Number Information
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NPI Number | 1275871352
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Entity Type | Individual
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Provider Name | MICHELLE ORTIZ PENA PSY.D
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Gender | Female
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 1607 AVE PONCE DE LEON STE 305
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City | SAN JUAN
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State | PR
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Zip | 00909-1815
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Country | US
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Telephone | 787-420-2626
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Fax | 787-998-1230
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Provider Business Mailing Address
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Address Line | 1405 PASEO DEGETAU
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City | CAGUAS
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State | PR
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Zip | 00727-2908
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Country | US
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Telephone | 787-420-2626
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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 | 004710
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License Number State | PR
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