Provider Demographics
NPI:1073311981
Name:ORTEGA BORROTO, MARIANELA
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:ORTEGA BORROTO
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 1:4824 VIA BARI APT 2305
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6830
Mailing Address - Country:US
Mailing Address - Phone:561-913-3950
Mailing Address - Fax:561-913-3950
Practice Address - Street 1:4793 N CONGRESS AVE STE 203204
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7937
Practice Address - Country:US
Practice Address - Phone:561-429-3863
Practice Address - Fax:561-448-6063
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-407116106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician