Provider Demographics
NPI:1972148252
Name:ORTEGA, LIZ (RBT)
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 W 4TH AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5031
Mailing Address - Country:US
Mailing Address - Phone:786-439-4574
Mailing Address - Fax:
Practice Address - Street 1:7355 W 4TH AVE APT 314
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5031
Practice Address - Country:US
Practice Address - Phone:786-439-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-44552106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician