Provider Demographics
NPI:1649201567
Name:ORTIZ- MARTINEZ, AIDA LUZ (PHD; PSYD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:LUZ
Last Name:ORTIZ- MARTINEZ
Suffix:
Gender:F
Credentials:PHD; PSYD
Other - Prefix:DR
Other - First Name:AIDA
Other - Middle Name:LUZ
Other - Last Name:ORTIZ-MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD; PSYD
Mailing Address - Street 1:PO BOX 9121
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9121
Mailing Address - Country:US
Mailing Address - Phone:787-850-9093
Mailing Address - Fax:787-850-9094
Practice Address - Street 1:12 CALLE MIGUEL CASILLAS
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3638
Practice Address - Country:US
Practice Address - Phone:787-850-9093
Practice Address - Fax:787-850-9094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1574103TF0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCRUZ AZULOtherCRUZ AZUL DE PR
PR11475OtherUNITED HEALTHCARE
PR61-00141OtherCOSMOS
PR15-1574OtherMCS
PR8-9247Medicare ID - Type UnspecifiedMEDICARE