Provider Demographics
NPI:1649914946
Name:ORTIZ, ANDREINA L
Entity type:Individual
Prefix:
First Name:ANDREINA
Middle Name:L
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREINA
Other - Middle Name:L
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25410 SW 137TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5692
Mailing Address - Country:US
Mailing Address - Phone:786-675-7186
Mailing Address - Fax:
Practice Address - Street 1:25410 SW 137TH AVE APT 202
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5692
Practice Address - Country:US
Practice Address - Phone:786-675-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB714123106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician