Provider Demographics
NPI:1366673758
Name:ORTIZ MEDINA, INES (TRABAJADOR SOCIAL)
Entity Type:Individual
Prefix:PROF
First Name:INES
Middle Name:
Last Name:ORTIZ MEDINA
Suffix:
Gender:F
Credentials:TRABAJADOR SOCIAL
Other - Prefix:PROF
Other - First Name:INES
Other - Middle Name:
Other - Last Name:ORTIZ MEDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRABAJADOR SOCIAL
Mailing Address - Street 1:HC 9 BOX 16019
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9749
Mailing Address - Country:US
Mailing Address - Phone:787-486-2411
Mailing Address - Fax:
Practice Address - Street 1:HC 9 BOX 16019
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731-9749
Practice Address - Country:US
Practice Address - Phone:787-486-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4490845172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver