Provider Demographics
NPI:1013527738
Name:ORTIZ, RAQUEL ANNA (BA)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ANNA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2608
Mailing Address - Country:US
Mailing Address - Phone:609-314-5237
Mailing Address - Fax:
Practice Address - Street 1:506 2ND ST
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2608
Practice Address - Country:US
Practice Address - Phone:609-314-5237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities