Provider Demographics
NPI:1821785692
Name:ORTIZ CALDERON, JEAN CARLOS (MA)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:CARLOS
Last Name:ORTIZ CALDERON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALLE COLOMBIA
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5801
Mailing Address - Country:US
Mailing Address - Phone:939-439-9837
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE COLOMBIA
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-5801
Practice Address - Country:US
Practice Address - Phone:939-439-9837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6853103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist