Provider Demographics
NPI:1295457125
Name:ORTIZ, LYNNETTE Y
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:Y
Last Name:ORTIZ
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 1:7614 SWILCAN DR APT 19101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5090
Mailing Address - Country:US
Mailing Address - Phone:787-453-7413
Mailing Address - Fax:
Practice Address - Street 1:7614 SWILCAN DR APT 19101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5090
Practice Address - Country:US
Practice Address - Phone:787-453-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation