Provider Demographics
NPI:1366646408
Name:ORTIZ, CARMEN MIRTA
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MIRTA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PARQUE REAL
Mailing Address - Street 2:CALLE DIAMANTE 35
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-5843
Mailing Address - Fax:787-832-6771
Practice Address - Street 1:CENTRO SALUD MENTAL DE MAYAGUEZ
Practice Address - Street 2:410 AVE HOSTOS SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-832-6770
Practice Address - Fax:787-832-6771
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator