MEDICARE: MR. JOSE J. ORTIZ PSY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	4315	PR

General Provider Information

NPI Number	:	1134472749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE J. ORTIZ PSY

Provider Business Mailing Address
First Line	:	URB LA PLATA CALLE RUBI
Second Line	:	K-7
City	:	CAYEY
State	:	PR
Zip	:	00736-4858
Country	:	US
Telephone Number	:	787-586-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	K7 CALLE RUBI
Second Line	:	LA PLATA
City	:	CAYEY
State	:	PR
Zip	:	00736-4858
Country	:	US
Telephone Number	:	787-586-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	10/19/2012

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