Provider Demographics
NPI:1598280711
Name:ORTEGA PEREZ, MERCEDES B
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:B
Last Name:ORTEGA PEREZ
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 1:5230 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1102
Mailing Address - Country:US
Mailing Address - Phone:787-318-4160
Mailing Address - Fax:
Practice Address - Street 1:5230 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1102
Practice Address - Country:US
Practice Address - Phone:786-318-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty