MEDICARE: DR. BRENDA L ORTIZ MATOS DSW

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	1041C0700X	Clinical Social Worker	6781	PR

General Provider Information

NPI Number	:	1538393525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA L ORTIZ MATOS DSW

Provider Business Mailing Address
First Line	:	8182 CALLE CAMELIA
Second Line	:	URB VISTAS DEL OCEANO
City	:	LOIZA
State	:	PR
Zip	:	00772-9726
Country	:	US
Telephone Number	:	787-469-4875
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE ALONDRA PLAZA 65 SHOPPING CENTER SUITE 2
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-0000
Country	:	US
Telephone Number	:	787-469-4875
Fax Number	:

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

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	11/24/2023

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