Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 5519 | PR |
NPI | 1013393644 |
---|---|
Provider Name | Dr. Orlando Javier Ostolaza |
First Address | Ponce, PR 00717-1012 |
Second Address | Ponce, PR 00717-1012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 05/08/2015 |