Provider Demographics
NPI:1164737474
Name:ORTIZ, CARLA J
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:ORTIZ
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 1:132-13 VILLA CAROLINA
Mailing Address - Street 2:AVE. ROBERTO CLEMENTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-7329
Mailing Address - Country:US
Mailing Address - Phone:787-216-3156
Mailing Address - Fax:
Practice Address - Street 1:3919 ISLA VERDE AVENUE
Practice Address - Street 2:COND. REEF APT 3-FTOWER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6716
Practice Address - Country:US
Practice Address - Phone:787-216-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0005221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical