Provider Demographics
NPI:1932328598
Name:RIVERA ORTIZ, JOAN (PH D)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:RIVERA ORTIZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COND GARDEN VW APT 43
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4283
Mailing Address - Country:US
Mailing Address - Phone:787-219-0833
Mailing Address - Fax:
Practice Address - Street 1:COUNTRY CLUB
Practice Address - Street 2:GO 4B CAMPO RICO AVE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-219-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical