Provider Demographics
NPI:1083075519
Name:ORTIZ, LOIDA EUNICE
Entity Type:Individual
Prefix:
First Name:LOIDA
Middle Name:EUNICE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20301 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-5944
Mailing Address - Country:US
Mailing Address - Phone:909-241-1694
Mailing Address - Fax:
Practice Address - Street 1:6180 BROCKTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2228
Practice Address - Country:US
Practice Address - Phone:909-241-1694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist