Provider Demographics
NPI:1679298319
Name:ORTIZ, JENNY LIZ
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LIZ
Last Name:ORTIZ
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:VENUS GARDENS CUPEY
Mailing Address - Street 2:CALLE OBREGON 687
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-204-5605
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL REGIONAL
Practice Address - Street 2:URB. SANTA JUANITA, 100 AV. LAUREL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-338-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001755101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR06159322Medicaid