Provider Demographics
NPI:1649440678
Name:LUCIANO ORTEGA, WANDA C (PSYD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:C
Last Name:LUCIANO ORTEGA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:C
Other - Last Name:LUCIANO ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 CALLE DEL RIO
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00912-4234
Mailing Address - Country:US
Mailing Address - Phone:787-463-8310
Mailing Address - Fax:
Practice Address - Street 1:412 CALLE DEL RIO
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-4234
Practice Address - Country:US
Practice Address - Phone:787-463-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist