Provider Demographics
NPI:1336207133
Name:ORTEGA CUESTA, JOSE LUIS (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:ORTEGA CUESTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:A8 AVE DEGETAU
Mailing Address - Street 2:BOMEVILLE TERRACE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5836
Mailing Address - Country:US
Mailing Address - Phone:787-258-5697
Mailing Address - Fax:787-747-2436
Practice Address - Street 1:A8 AVE DEGETAU
Practice Address - Street 2:BONNEVILLE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5836
Practice Address - Country:US
Practice Address - Phone:787-258-5697
Practice Address - Fax:787-747-2436
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR1041103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist