Provider Demographics
NPI:1225258544
Name:ORTIZ, BEATRIZ PROVIDENCIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:PROVIDENCIA
Last Name:ORTIZ
Suffix:
Gender:F
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:TOLOSA ST. #15 SULTANA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-313-4176
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE NELSON PEREA
Practice Address - Street 2:EDIF. DR. CENTER SUITE #103
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4949
Practice Address - Country:US
Practice Address - Phone:787-313-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2197103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist