Provider Demographics
NPI:1245042712
Name:ORTIZ, DAIANNA L (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAIANNA
Middle Name:L
Last Name:ORTIZ
Suffix:
Gender:
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:URB. CIBUCO CALLE 4 F-60
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-2336
Mailing Address - Country:US
Mailing Address - Phone:787-702-6138
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA AGUSTIN RAMOS CALERO INTERIOR CARRETERA 112
Practice Address - Street 2:KM 1.4 SUITE #9
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-702-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical