Provider Demographics
NPI:1790324242
Name:RODRIGUEZ ORTIZ, HEYSHA M SR (DOCTORADO)
Entity Type:Individual
Prefix:DR
First Name:HEYSHA
Middle Name:M
Last Name:RODRIGUEZ ORTIZ
Suffix:SR
Gender:F
Credentials:DOCTORADO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CALLE PESCADOR
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-9438
Mailing Address - Country:US
Mailing Address - Phone:787-692-5306
Mailing Address - Fax:
Practice Address - Street 1:208 CALLE PESCADOR
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-9438
Practice Address - Country:US
Practice Address - Phone:787-692-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6567103TC0700X
PR9752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty