Provider Demographics
NPI:1417636150
Name:JIMENEZ-ORTIZ, DARISELLE (MS)
Entity type:Individual
Prefix:
First Name:DARISELLE
Middle Name:
Last Name:JIMENEZ-ORTIZ
Suffix:
Gender:
Credentials:MS
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 5201
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-5201
Mailing Address - Country:US
Mailing Address - Phone:787-651-7450
Mailing Address - Fax:
Practice Address - Street 1:12.7 CARR 368 BO SUSUA BAJA
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-2501
Practice Address - Country:US
Practice Address - Phone:787-651-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical