Provider Demographics
NPI:1184022006
Name:ORTIZ GARCIA, ANGELICA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:ORTIZ GARCIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 MAIN ST
Mailing Address - Street 2:APT. 304
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2254
Mailing Address - Country:US
Mailing Address - Phone:787-672-8111
Mailing Address - Fax:
Practice Address - Street 1:6471 MAIN ST
Practice Address - Street 2:APT. 304
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2254
Practice Address - Country:US
Practice Address - Phone:787-672-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist