Provider Demographics
NPI:1346391158
Name:DE PAZ ORTIZ, ANNETTE (PSYD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:DE PAZ ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ISLABELLA # 28 GRAN BULEVAR DE LOS PRADOS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-653-2549
Mailing Address - Fax:
Practice Address - Street 1:PONCE DE LEON AVE. #623
Practice Address - Street 2:SUITE 601-B BANCO COOPERATIVO PLAZA
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-635-7177
Practice Address - Fax:787-653-2549
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical