Provider Demographics
NPI:1447076435
Name:ORTIZ TELLEZ, ROXANA
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:ORTIZ TELLEZ
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 1:15470 SW 82ND LN APT 327
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1251
Mailing Address - Country:US
Mailing Address - Phone:786-781-4914
Mailing Address - Fax:
Practice Address - Street 1:15470 SW 82ND LN APT 327
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1251
Practice Address - Country:US
Practice Address - Phone:786-781-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician