Michelle Ortiz Pena, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

004710 Issued in PR

Practice address

1607 Ave Ponce de Leon Ste 305
San Juan, PR 00909-1815

Phone

(787) 420-2626

Fax

(787) 998-1230

NPI assigned

Jan 23, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1275871352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 PASEO DEGETAU",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "007272908",
            "telephone_number": "787-420-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 AVE PONCE DE LEON STE 305",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009091815",
            "telephone_number": "787-420-2626",
            "fax_number": "787-998-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ PENA",
        "first_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-23",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "004710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda L Ortiz Matos, DSW
• Camila Alexandra Ortiz Mendez
• Carmen Belisa Ortiz Miranda, MSW, ED.D.
• Marisol Ortiz Morell
• Edwin Gabriel Ortiz Munoz
• Mariemyr Ortiz Perez, LCSW
• Luisa Fernanda Ortiz Reyes, PSYD
• Camille Ortiz Rivera, PHARMD
• David Ortiz Rivera, MD
• Stephanie Nicole Ortiz Rivera

• Clinical Psychologist in San Juan, PR
• Providers in San Juan, PR by specialty
• Clinical Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.