Provider Demographics
NPI:1750884961
Name:ORTIZ BAUTISTA, MARIA ANGELICA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:ORTIZ BAUTISTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 147TH ST APT 2K
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3584
Mailing Address - Country:US
Mailing Address - Phone:347-779-6134
Mailing Address - Fax:
Practice Address - Street 1:7831 147TH ST APT 2K
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-3584
Practice Address - Country:US
Practice Address - Phone:347-779-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY028499-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program