Provider Demographics
NPI:1134460579
Name:ORTIZ, SYLVIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17662 IRVINE BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3132
Mailing Address - Country:US
Mailing Address - Phone:714-726-2794
Mailing Address - Fax:714-997-8274
Practice Address - Street 1:17662 IRVINE BLVD STE 7
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3132
Practice Address - Country:US
Practice Address - Phone:714-726-2794
Practice Address - Fax:714-997-8274
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS292551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical