Provider Demographics
NPI:1013393644
Name:OSTOLAZA, ORLANDO JAVIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:JAVIER
Last Name:OSTOLAZA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 PERPETUO SOCORRO
Mailing Address - Street 2:SANTA MARIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1012
Mailing Address - Country:US
Mailing Address - Phone:787-601-5284
Mailing Address - Fax:
Practice Address - Street 1:7490 PERPETUO SOCORRO
Practice Address - Street 2:SANTA MARIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1012
Practice Address - Country:US
Practice Address - Phone:787-601-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5519103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling