Provider Demographics
NPI:1316769508
Name:ORTEGA MARTELL, ROCIO DILAIDA
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:DILAIDA
Last Name:ORTEGA MARTELL
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 1:7763 PANAMA ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3563
Mailing Address - Country:US
Mailing Address - Phone:786-719-9321
Mailing Address - Fax:
Practice Address - Street 1:7763 PANAMA ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3563
Practice Address - Country:US
Practice Address - Phone:786-719-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-388700106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty