Provider Demographics
NPI:1013583145
Name:ORTIZ, NOAH JOVAN
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:JOVAN
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 COLLEGE PARK DR APT B31
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1643
Mailing Address - Country:US
Mailing Address - Phone:440-723-0924
Mailing Address - Fax:
Practice Address - Street 1:347 MIDWAY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2496
Practice Address - Country:US
Practice Address - Phone:440-324-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator