Provider Demographics
NPI:1821377102
Name:ORTIZ, KEILA B (MA PSYC)
Entity Type:Individual
Prefix:MRS
First Name:KEILA
Middle Name:B
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MA PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. DIPLO
Mailing Address - Street 2:CALLE 18 Q 36
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718
Mailing Address - Country:US
Mailing Address - Phone:787-597-0826
Mailing Address - Fax:
Practice Address - Street 1:URB. DIPLO
Practice Address - Street 2:CALLE 18 Q 36
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-597-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003611103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool