Provider Demographics
NPI:1811730559
Name:ORTEGA ALBA, ILIANYS
Entity type:Individual
Prefix:
First Name:ILIANYS
Middle Name:
Last Name:ORTEGA ALBA
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 1:575 W 51ST PL APT C1
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3626
Mailing Address - Country:US
Mailing Address - Phone:305-942-5703
Mailing Address - Fax:
Practice Address - Street 1:575 W 51ST PL APT C1
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3626
Practice Address - Country:US
Practice Address - Phone:305-942-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician