Provider Demographics
NPI:1679700702
Name:ORTIZ, MYRIAM J (MA, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:J
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 CALLE PICAFLOR
Mailing Address - Street 2:QUINTAS DE CABO ROJO
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-4229
Mailing Address - Country:US
Mailing Address - Phone:787-616-9527
Mailing Address - Fax:
Practice Address - Street 1:182 CALLE PICAFLOR
Practice Address - Street 2:QUINTAS DE CABO ROJO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4229
Practice Address - Country:US
Practice Address - Phone:787-616-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist