Provider Demographics
NPI:1093423873
Name:ORTIZ, SHEREEN EBONY
Entity Type:Individual
Prefix:
First Name:SHEREEN
Middle Name:EBONY
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 1:2 EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1841
Mailing Address - Country:US
Mailing Address - Phone:415-314-4402
Mailing Address - Fax:
Practice Address - Street 1:728 BARTLETT AVE # 4
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3614
Practice Address - Country:US
Practice Address - Phone:415-314-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)