Provider Demographics
NPI:1912666207
Name:ORTIZ ROLON, EFRAIN SR
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:ORTIZ ROLON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EFRAIN
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PMB 249 PO BOX 6400
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-6400
Mailing Address - Country:US
Mailing Address - Phone:787-361-5705
Mailing Address - Fax:
Practice Address - Street 1:CARR. 845 INT. 199
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-755-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
PR4849103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool