Provider Demographics
NPI:1669810933
Name:HERIBERTO M. ORTIZ, PSY.D., P.A.
Entity type:Organization
Organization Name:HERIBERTO M. ORTIZ, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERIBERTO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-274-2403
Mailing Address - Street 1:7700 N KENDALL DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7564
Mailing Address - Country:US
Mailing Address - Phone:305-274-2403
Mailing Address - Fax:305-274-2433
Practice Address - Street 1:7700 N KENDALL DR
Practice Address - Street 2:SUITE 415
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7564
Practice Address - Country:US
Practice Address - Phone:305-274-2403
Practice Address - Fax:305-274-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6187103T00000X
FL549103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54638Medicare PIN