Provider Demographics
NPI:1154886653
Name:ORTIZ PENA, ITZEL LEILANI
Entity type:Individual
Prefix:
First Name:ITZEL
Middle Name:LEILANI
Last Name:ORTIZ PENA
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 1:11 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4510
Mailing Address - Country:US
Mailing Address - Phone:313-265-7905
Mailing Address - Fax:
Practice Address - Street 1:307 W 38TH ST RM 817
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3541
Practice Address - Country:US
Practice Address - Phone:212-695-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management