Provider Demographics
NPI:1003528977
Name:ORTEGA, VALERIA BEATRIZ
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:BEATRIZ
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 LUXEMBURG CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5095
Mailing Address - Country:US
Mailing Address - Phone:561-704-8362
Mailing Address - Fax:
Practice Address - Street 1:400 COLUMBIA DR STE 110
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1948
Practice Address - Country:US
Practice Address - Phone:561-412-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLO632862019600106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician