Provider Demographics
NPI:1235918491
Name:ORTEGA, SARAH VICTORIA (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:VICTORIA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:VICTORIA
Other - Last Name:ALFONSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:10956 SW 75TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2739
Mailing Address - Country:US
Mailing Address - Phone:786-897-5187
Mailing Address - Fax:
Practice Address - Street 1:4770 BISCAYNE BLVD STE 740
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3244
Practice Address - Country:US
Practice Address - Phone:305-571-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLXXXXXXX103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical