Provider Demographics
NPI:1336634393
Name:MANTARAS-ORTIZ, CLAUDIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:
Last Name:MANTARAS-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 1:1605 AVE PONCE DE LEON STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1895
Mailing Address - Country:US
Mailing Address - Phone:787-203-7700
Mailing Address - Fax:
Practice Address - Street 1:1605 AVE PONCE DE LEON STE 100
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1895
Practice Address - Country:US
Practice Address - Phone:787-203-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6076103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical