Provider Demographics
NPI:1750857553
Name:PEREZ ORTIZ, YARITZA
Entity Type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:PEREZ 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:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-2369
Mailing Address - Country:US
Mailing Address - Phone:787-462-5805
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE MARGINAL
Practice Address - Street 2:URB VALENCIA 1
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-0077
Practice Address - Country:US
Practice Address - Phone:787-679-6569
Practice Address - Fax:787-734-1633
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR50692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR06006610012Medicaid