Provider Demographics
NPI:1649151333
Name:ORTIZ, MINERVA VIDAL (CCHW)
Entity type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:VIDAL
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:MRS
Other - First Name:MINY
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCHW
Mailing Address - Street 1:1516 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3223
Mailing Address - Country:US
Mailing Address - Phone:401-785-2666
Mailing Address - Fax:
Practice Address - Street 1:1516 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3223
Practice Address - Country:US
Practice Address - Phone:401-785-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker