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General NPI Number Information
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NPI Number | 1528789633
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Entity Type | Individual
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Provider Name | DEREK ISRAEL ORTIZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | PIEDRAS BLANCAS CAM RODRIGUEZ SABANA YEGUAS CARR 101 KM 5.6
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City | LAJAS
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State | PR
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Zip | 00667
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Country | US
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Telephone | 787-519-8942
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3190
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City | LAJAS
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State | PR
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Zip | 00667-3190
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Country | US
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Telephone | 305-833-6625
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | TPPY2854
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 007404
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License Number State | PR
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