Provider Demographics
NPI:1396560769
Name:ORTIZ PALMA, KEYLIN LILIBETH
Entity type:Individual
Prefix:
First Name:KEYLIN
Middle Name:LILIBETH
Last Name:ORTIZ PALMA
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 1:4964 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7071
Mailing Address - Country:US
Mailing Address - Phone:561-410-4073
Mailing Address - Fax:
Practice Address - Street 1:4964 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470-7071
Practice Address - Country:US
Practice Address - Phone:561-410-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-394253106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician