Provider Demographics
NPI:1144417262
Name:ORTIZ, ANNE S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:S
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORETTA
Other - Middle Name:ANNE SALAZAR
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1916 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4026
Mailing Address - Country:US
Mailing Address - Phone:575-799-1412
Mailing Address - Fax:575-935-2122
Practice Address - Street 1:1916 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4026
Practice Address - Country:US
Practice Address - Phone:575-935-2121
Practice Address - Fax:575-935-2122
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-06532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2007-0653OtherSTATE LICENSE