Individual
CARMEN YADIRA ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5263 VILLA ROSA AVE, SAINT CLOUD, FL 34771-7849
(787) 690-6104
Mailing address
2108 WALDEN PARK CIR APT 203, KISSIMMEE, FL 34744-6310
(787) 690-6104
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
11/05/2018
Last updated
03/07/2019
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