Provider Demographics
NPI:1174137194
Name:ORTIZ MARTINEZ, LAURA IVETTE
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:IVETTE
Last Name:ORTIZ MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS DE BUENA VISTA
Mailing Address - Street 2:L7 CALLE MITRA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5957
Mailing Address - Country:US
Mailing Address - Phone:787-376-0409
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DE BUENA VISTA
Practice Address - Street 2:L7 CALLE MITRA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-5957
Practice Address - Country:US
Practice Address - Phone:787-376-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty