Provider Demographics
NPI:1245497684
Name:ORTIZ OLIVERAS, BRENDA
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:ORTIZ OLIVERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SAN AGUSTIN 92
Mailing Address - Street 2:CALLE SAN BERNARDO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-854-1426
Mailing Address - Fax:787-884-3757
Practice Address - Street 1:EDIF LAS VEGAS 420 BO CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1426
Practice Address - Fax:787-884-3757
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist