Provider Demographics
NPI:1255495412
Name:CASAS DOLZ, INGRID LETICIA (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:LETICIA
Last Name:CASAS DOLZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 N SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3536
Mailing Address - Country:US
Mailing Address - Phone:407-823-8421
Mailing Address - Fax:407-482-2389
Practice Address - Street 1:CENTRO SALUD MENTAL, SAN JUAN BAUTISTA MEDICAL CENTER
Practice Address - Street 2:CALL BOX 4964
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-4964
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:787-653-0525
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR148732084P0800X, 2084P0804X
FLACN9452084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry