Provider Demographics
NPI:1255126439
Name:ORTIZ, MAGALY
Entity type:Individual
Prefix:
First Name:MAGALY
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-06 BOX 15133
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9810
Mailing Address - Country:US
Mailing Address - Phone:787-481-3084
Mailing Address - Fax:
Practice Address - Street 1:HC-06 BOX 15133
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9810
Practice Address - Country:US
Practice Address - Phone:787-481-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional