Provider Demographics
NPI:1629543988
Name:ROSARIO ORTIZ, AGNES EUNICE (PSYD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:EUNICE
Last Name:ROSARIO 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. RIO CANAS
Mailing Address - Street 2:2327 CALLE YAGUEZ
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-221-5821
Mailing Address - Fax:
Practice Address - Street 1:CALLE GUILLERMO ESTEVES, NUMERO 49
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-705-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical