Provider Demographics
NPI:1750585071
Name:ORTIZ MARTINEZ, GLORIA E (PHD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:E
Last Name:ORTIZ MARTINEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:E
Other - Last Name:ORTIZ MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR
Mailing Address - Street 1:URB BAIROA CALLE STA MARIA M-4 #3170
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-608-7484
Mailing Address - Fax:
Practice Address - Street 1:CALLE D-H6, URB. BAIROA GOLDEN GATE I
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-1138
Practice Address - Country:US
Practice Address - Phone:787-608-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1060103T00000X, 103T00000X
NY1403860103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool