Provider Demographics
NPI:1679813042
Name:ORTIZ, RAQUEL (MFCT)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MFCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 STREET.
Mailing Address - Street 2:AP32 REXVILLE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-390-6874
Mailing Address - Fax:
Practice Address - Street 1:100 PASEO SAN PABLO, EDIFICIO ARTURO CADILLA
Practice Address - Street 2:SUITE 208, HOSPITAL HIMA SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-787-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional