Provider Demographics
NPI:1952727307
Name:LOPEZ ORTIZ, JESSICA MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MICHELLE
Last Name:LOPEZ ORTIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PAISAJES DE DORADO
Mailing Address - Street 2:106 JACARANDA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-449-5865
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MEDICO SANTA CRUZ #73
Practice Address - Street 2:SUITE 405
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-4592
Practice Address - Fax:787-798-8236
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical