Individual provider Active NPI

Eduin Eladio Caceres Ortiz

  • Clinical Psychologist
  • San Juan, PR
National Provider Identifier
1629606611
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6184 Issued in PR
Practice address
1479 Ave Ashford Ste 6
San Juan, PR 00907-1583
Phone
(787) 513-3055
NPI assigned
Mar 27, 2020
Last updated
Aug 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 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 6184 PR Primary

Addresses

Primary practice location

1479 Ave Ashford Ste 6
San Juan, PR 00907-1583

Mailing address

1 Calle Poppy Apt B2
Urb. Parque Forestal
San Juan, PR 00926
Phone (787) 513-3055

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
I20200415003412 PR Practitioner - Clinical Psychologist 3173953130 Practice locations: San Juan, PR

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6184PRMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Instituto de Bienestar Especializado En Trauma Psicologico LLC Clinical CurrentSince Mar 29, 2020 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1629606611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CALLE POPPY APT B2",
            "address_2": "URB. PARQUE FORESTAL",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-513-3055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1479 AVE ASHFORD STE 6",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009071583",
            "telephone_number": "787-513-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACERES ORTIZ",
        "first_name": "EDUIN",
        "middle_name": "ELADIO",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "6184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.