Provider Demographics
NPI:1316284169
Name:ROSARIO ORTIZ, HERMES G (PSYD)
Entity type:Individual
Prefix:
First Name:HERMES
Middle Name:G
Last Name:ROSARIO ORTIZ
Suffix:
Gender:M
Credentials:PSYD
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 1635
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1635
Mailing Address - Country:US
Mailing Address - Phone:787-244-1475
Mailing Address - Fax:
Practice Address - Street 1:CARR. 417 KM 2.7 BO MALPASO
Practice Address - Street 2:EDIF. CARRIBEAN OFFICE PARK
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004639103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical