Basic Information
Provider Information | |||||||||
NPI: | 1902127467 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ORTIZ GIL | ||||||||
FirstName: | SANDRA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SANDRA | ||||||||
OtherFirstName: | ORTIZ | ||||||||
OtherMiddleName: | GIL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PH.D | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 536 | ||||||||
Address2: |   | ||||||||
City: | CAGUAS | ||||||||
State: | PR | ||||||||
PostalCode: | 007260536 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7874600626 | ||||||||
FaxNumber: | 7877917223 | ||||||||
Practice Location | |||||||||
Address1: | 62 CALLE ASTROS | ||||||||
Address2: |   | ||||||||
City: | CAROLINA | ||||||||
State: | PR | ||||||||
PostalCode: | 009791727 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7876168020 | ||||||||
FaxNumber: | 7877917223 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2010 | ||||||||
LastUpdateDate: | 08/03/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 3335 | PR | Y |   | Behavioral Health & Social Service Providers | Psychologist |   |
No ID Information.