Provider Demographics
NPI:1659502532
Name:RIVERA-ORTIZ, MAYRA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:RIVERA-ORTIZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6657 KESTREL CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1364
Mailing Address - Country:US
Mailing Address - Phone:239-410-9414
Mailing Address - Fax:
Practice Address - Street 1:6657 KESTREL CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1364
Practice Address - Country:US
Practice Address - Phone:239-410-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist