Provider Demographics
NPI:1700769783
Name:ORTIZ RODRIGUEZ, JAED MARIE (MED)
Entity type:Individual
Prefix:
First Name:JAED
Middle Name:MARIE
Last Name:ORTIZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 7504
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-9408
Mailing Address - Country:US
Mailing Address - Phone:787-615-5672
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 7504
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-9408
Practice Address - Country:US
Practice Address - Phone:787-615-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7405103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool