Provider Demographics
NPI:1033329032
Name:ORTEGA, VIVIAN M (MS)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:M
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CALLE ORTEGON
Mailing Address - Street 2:LADERAS DE SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9325
Mailing Address - Country:US
Mailing Address - Phone:787-641-0474
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE AQUAMARINA
Practice Address - Street 2:VILLA BLANCA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1908
Practice Address - Country:US
Practice Address - Phone:787-743-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist