Provider Demographics
NPI:1124169891
Name:ORTIZ APONTE, VIVIAN A (PYCOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:A
Last Name:ORTIZ APONTE
Suffix:
Gender:F
Credentials:PYCOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0451
Mailing Address - Country:US
Mailing Address - Phone:787-735-3245
Mailing Address - Fax:787-735-3245
Practice Address - Street 1:3 CALLE GERONIMO MARTINEZ
Practice Address - Street 2:ALTOS
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3660
Practice Address - Country:US
Practice Address - Phone:787-735-3245
Practice Address - Fax:787-735-3245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1336103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist