MEDICARE: DIANDRA ORTIZ LMHC

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	101YM0800X	Mental Health Counselor	MH21995.	FL

General Provider Information

NPI Number	:	1841995313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANDRA ORTIZ LMHC

Provider Business Mailing Address
First Line	:	11200 BISCAYNE BLVD PH 29
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33181-3467
Country	:	US
Telephone Number	:	178-647-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	11200 BISCAYNE BLVD PH 29
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33181-3467
Country	:	US
Telephone Number	:	178-647-0911
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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