Provider Demographics
NPI:1982665238
Name:ORTIZ, ROSALYN I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSALYN
Middle Name:I
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ABRAHAM
Mailing Address - Street 2:74 LA PROVIDENCIA
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-598-3112
Mailing Address - Fax:787-767-3412
Practice Address - Street 1:1056 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 701
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00927-5015
Practice Address - Country:US
Practice Address - Phone:787-598-3112
Practice Address - Fax:787-767-3412
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57226Medicare PIN
PRQ43904Medicare UPIN