Individual provider Active NPI

Dariselle Jimenez-Ortiz, PHD

  • Clinical Psychologist
  • Caguas, PR
National Provider Identifier
1417636150
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
8174 Issued in PR
Practice address
A18 Ave Degetau
Caguas, PR 00725-5837
Phone
(939) 745-5500
Fax
(561) 944-8003
NPI assigned
Jul 11, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 8174 PR Primary

Addresses

Primary practice location

A18 Ave Degetau
Caguas, PR 00725-5837

Mailing address

PO Box 262212
San Juan, PR 00926-2653
Phone (939) 745-5500

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250729000129 PR Practitioner - Clinical Psychologist 8022525765 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Neurowellness,LLC CurrentSince May 24, 2025 Accepting new patients
Alzheimer's Prevention Center, LLC CurrentSince Jun 3, 2025 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1417636150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 262212",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009262653",
            "telephone_number": "939-745-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "A18 AVE DEGETAU",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "007255837",
            "telephone_number": "939-745-5500",
            "fax_number": "561-944-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ-ORTIZ",
        "first_name": "DARISELLE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-11",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "8174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caguas, PR

Sources for this page

Verify at the official NPI Registry.