Provider Demographics
NPI:1689811499
Name:ORTIZ, NILSA
Entity Type:Individual
Prefix:
First Name:NILSA
Middle Name:
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:P.O. BOX 60401
Mailing Address - Street 2:PMB 150
Mailing Address - City:AGUADILLA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00604
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BARRIO COCOS
Practice Address - Street 2:CARR. #2 KM. 96.8
Practice Address - City:QUEBRADILLAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00678
Practice Address - Country:UM
Practice Address - Phone:787-895-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist