MEDICARE: DR. KEISHLA MEDINA ORTIZ

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	6237	PR

General Provider Information

NPI Number	:	1275097966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEISHLA MEDINA ORTIZ

Provider Business Mailing Address
First Line	:	PO BOX 1075
Second Line	:
City	:	SAN LORENZO
State	:	PR
Zip	:	00754-1075
Country	:	US
Telephone Number	:	939-451-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	H21 CALLE JOSE VILLARES
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-2463
Country	:	US
Telephone Number	:	939-451-1001
Fax Number	:

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

Provider Enumeration Date	:	01/26/2019
Last Update Date	:	04/23/2025

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