Provider Demographics
NPI:1073341186
Name:MIRANDA-ORTIZ, RAYSA ENID
Entity type:Individual
Prefix:MISS
First Name:RAYSA
Middle Name:ENID
Last Name:MIRANDA-ORTIZ
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:MY9 CALLE 436
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-1804
Mailing Address - Country:US
Mailing Address - Phone:787-688-3633
Mailing Address - Fax:
Practice Address - Street 1:MY9 CALLE 436
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-1804
Practice Address - Country:US
Practice Address - Phone:787-688-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty