Provider Demographics
NPI:1134351794
Name:ORTIZ, JORGE M (MSW)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MSW
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 2118
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2118
Mailing Address - Country:US
Mailing Address - Phone:787-478-2692
Mailing Address - Fax:
Practice Address - Street 1:W16 CALLE ONIX
Practice Address - Street 2:VALLE DE CERRO GORDO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6865
Practice Address - Country:US
Practice Address - Phone:787-478-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical