Provider Demographics
NPI:1851095947
Name:BROCO ORTIZ, JULIANA (MS)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:BROCO ORTIZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB CIELO DORADO VILLAGE
Mailing Address - Street 2:97 CALLE ESMERAL
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-204-1617
Mailing Address - Fax:
Practice Address - Street 1:URB CIELO DORADO VILLAGE
Practice Address - Street 2:97 CALLE ESMERAL
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-204-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7122103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist