Provider Demographics
NPI:1730655515
Name:ORTIZ, CAROLINA DEL CARMEN (MASTER DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:DEL CARMEN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MASTER DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C11 SAN IGNACIO
Mailing Address - Street 2:SAN PEDRO ESTATES
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-679-8773
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DE CIUDAD JARDIN
Practice Address - Street 2:APT 815
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-975-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4250-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty