Provider Demographics
NPI:1760406631
Name:ORTIZ, HERIBERTO MAXIMO (PSYD , CAP)
Entity Type:Individual
Prefix:DR
First Name:HERIBERTO
Middle Name:MAXIMO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PSYD , CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 N KENDALL DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7564
Mailing Address - Country:US
Mailing Address - Phone:305-274-2403
Mailing Address - Fax:305-274-2433
Practice Address - Street 1:7700 N KENDALL DR
Practice Address - Street 2:SUITE 415
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7564
Practice Address - Country:US
Practice Address - Phone:305-274-2403
Practice Address - Fax:305-274-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6187103T00000X
FL549103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54638Medicare ID - Type Unspecified