Provider Demographics
NPI:1093574048
Name:ORTIZ, CANDACE B
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:B
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12428 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3113
Mailing Address - Country:US
Mailing Address - Phone:623-399-6159
Mailing Address - Fax:623-399-6416
Practice Address - Street 1:13851 W LA MAR BLVD STE D
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1389
Practice Address - Country:US
Practice Address - Phone:623-399-6159
Practice Address - Fax:623-399-6416
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-009565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist