Provider Demographics
NPI:1922676634
Name:ORTIZ COLON, JERIKALYS MARIAN
Entity Type:Individual
Prefix:
First Name:JERIKALYS
Middle Name:MARIAN
Last Name:ORTIZ COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. JARIDNES DE JAYUYA
Mailing Address - Street 2:195 C/ GLADIOLA
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-1611
Mailing Address - Country:US
Mailing Address - Phone:787-409-3317
Mailing Address - Fax:
Practice Address - Street 1:URB. JARIDNES DE JAYUYA
Practice Address - Street 2:195 C/ GLADIOLA
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1611
Practice Address - Country:US
Practice Address - Phone:787-409-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
PR142961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical