Provider Demographics
NPI:1427250463
Name:HERNANDEZ-ORTIZ, IDALY (MA)
Entity type:Individual
Prefix:MS
First Name:IDALY
Middle Name:
Last Name:HERNANDEZ-ORTIZ
Suffix:
Gender:F
Credentials:MA
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 191195
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1195
Mailing Address - Country:US
Mailing Address - Phone:787-787-7601
Mailing Address - Fax:787-787-7601
Practice Address - Street 1:RIVERSIDE PLAZA
Practice Address - Street 2:SUITE 17-J SANTA CRUZ ST. #74
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7030
Practice Address - Country:US
Practice Address - Phone:787-787-7601
Practice Address - Fax:787-787-7601
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist