Basic Information
| Provider Information | |||||||||
| NPI: | 1073737581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | MORAIMA | ||||||||
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| Credential: | TS | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 01 BOX 11491 | ||||||||
| Address2: | |||||||||
| City: | TOA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877973406 | ||||||||
| FaxNumber: | 7877647004 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF PUERTO RICO, MEDICAL SCIENCES CAMPUS | ||||||||
| Address2: | 9TH FLOOR OFFICE 954 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009365067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877647004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3196 | PR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.