Provider Demographics
NPI:1790986545
Name:ORTIZ, NYDIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 CALLE MARQUESA
Mailing Address - Street 2:URB. VALLE REAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0503
Mailing Address - Country:US
Mailing Address - Phone:787-813-5700
Mailing Address - Fax:787-844-5209
Practice Address - Street 1:1659 CALLE MARQUESA
Practice Address - Street 2:URB. VALLE REAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0503
Practice Address - Country:US
Practice Address - Phone:787-813-5700
Practice Address - Fax:787-844-5209
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0463103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist