Provider Demographics
NPI:1093478299
Name:ORTIZ ORTIZ, NADYNEM N (BA)
Entity Type:Individual
Prefix:
First Name:NADYNEM
Middle Name:N
Last Name:ORTIZ ORTIZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARCELAS HILL BROTHERS
Mailing Address - Street 2:359 CALLE 4
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3903
Mailing Address - Country:US
Mailing Address - Phone:787-244-2309
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 872 KM 0.9
Practice Address - Street 2:RIO PLANTATION
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00958
Practice Address - Country:US
Practice Address - Phone:787-787-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10392OtherTRABAJO SOCIAL