Provider Demographics
NPI:1316600919
Name:ORTEGA, FERNANDO (LICENSED SOCIAL WORK)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:LICENSED SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CALLE C
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4230
Mailing Address - Country:US
Mailing Address - Phone:178-734-5045
Mailing Address - Fax:
Practice Address - Street 1:85 CALLE C
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4230
Practice Address - Country:US
Practice Address - Phone:787-345-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR08113425Medicaid