Provider Demographics
NPI:1154188142
Name:MIRANDA ORTIZ, KARINA ELEDYS
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:ELEDYS
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:HC 1 BOX 5972
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-9261
Mailing Address - Country:US
Mailing Address - Phone:787-516-6083
Mailing Address - Fax:
Practice Address - Street 1:CARR 143 KM 36.2 INT
Practice Address - Street 2:BO BAUTA ABAJO SECTOR LA FRANCIA
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-9261
Practice Address - Country:US
Practice Address - Phone:787-516-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR155641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical