MEDICARE: INGRID LETICIA CASAS DOLZ MD

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	2084P0800X	Psychiatry Physician	14873	PR
2	2084P0804X	Child & Adolescent Psychiatry Physician	14873	PR
3	2084P0804X	Child & Adolescent Psychiatry Physician	ACN945	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255495412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID LETICIA CASAS DOLZ MD

Provider Business Mailing Address
First Line	:	1400 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3536
Country	:	US
Telephone Number	:	407-823-8421
Fax Number	:	407-482-2389

Provider Business Practice Location Address
First Line	:	CENTRO SALUD MENTAL, SAN JUAN BAUTISTA MEDICAL CENTER
Second Line	:	CALL BOX 4964
City	:	CAGUAS
State	:	PR
Zip	:	00726-4964
Country	:	US
Telephone Number	:	787-653-0550
Fax Number	:	787-653-0525

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	11/07/2017

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