Provider Demographics
NPI:1396315420
Name:ORTIZ MONDEJAR, ANNARAY
Entity type:Individual
Prefix:
First Name:ANNARAY
Middle Name:
Last Name:ORTIZ MONDEJAR
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 1:14562 SW 280TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8353
Mailing Address - Country:US
Mailing Address - Phone:786-349-8228
Mailing Address - Fax:
Practice Address - Street 1:14562 SW 280TH ST APT 303
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8353
Practice Address - Country:US
Practice Address - Phone:786-349-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty