Provider Demographics
NPI:1104176528
Name:DALLY RIOS ORTEGA, PSY.D., LLC
Entity type:Organization
Organization Name:DALLY RIOS ORTEGA, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLY
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIOS ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:804-519-2546
Mailing Address - Street 1:10294 CAROLINE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5865
Mailing Address - Country:US
Mailing Address - Phone:804-519-2546
Mailing Address - Fax:
Practice Address - Street 1:10294 CAROLINE PARK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5865
Practice Address - Country:US
Practice Address - Phone:804-519-2546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty