Provider Demographics
NPI:1922850098
Name:ORTIZ DE VILLATE, IDALIZ
Entity Type:Individual
Prefix:
First Name:IDALIZ
Middle Name:
Last Name:ORTIZ DE VILLATE
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 1:330 SPRINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5971
Mailing Address - Country:US
Mailing Address - Phone:787-231-7490
Mailing Address - Fax:
Practice Address - Street 1:330 SPRINGVIEW DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5971
Practice Address - Country:US
Practice Address - Phone:787-231-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor