Provider Demographics
NPI:1902127467
Name:ORTIZ-GIL, SANDRA (PHD)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:
Last Name:ORTIZ-GIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:ORTIZ-GIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:CALLE LOS ASTROS #62
Mailing Address - Street 2:URB. LOS ANGELES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1727
Mailing Address - Country:US
Mailing Address - Phone:787-618-8020
Mailing Address - Fax:
Practice Address - Street 1:CALLE ANTONIO JIMENEZ LANDRAU #90
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-944-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3335103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038970700Medicaid
PR7496OtherHUMANA