Provider Demographics
NPI:1215134671
Name:RODRIGUEZ ORTIZ, IXA YIZZET (PHD)
Entity type:Individual
Prefix:DR
First Name:IXA
Middle Name:YIZZET
Last Name:RODRIGUEZ ORTIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO PARQUE CENTRO,
Mailing Address - Street 2:APT. MAGA, F-4
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-376-2724
Mailing Address - Fax:
Practice Address - Street 1:AVE. MENDEZ VIGO
Practice Address - Street 2:# 332
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-376-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical