Provider Demographics
NPI:1316532781
Name:HERNANDEZ ORTIZ, RONALDO J SR
Entity type:Individual
Prefix:
First Name:RONALDO
Middle Name:J
Last Name:HERNANDEZ ORTIZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CALLE AUSUBO
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2905
Mailing Address - Country:US
Mailing Address - Phone:787-467-3500
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-3029
Practice Address - Country:US
Practice Address - Phone:787-847-4270
Practice Address - Fax:787-847-3057
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical