Provider Demographics
NPI:1225674807
Name:ORTIZ, JOSE JAMES JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:JAMES
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 BENTLEY COVE CT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4339
Mailing Address - Country:US
Mailing Address - Phone:503-530-0659
Mailing Address - Fax:
Practice Address - Street 1:104 KINKADE AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OR
Practice Address - Zip Code:97818
Practice Address - Country:US
Practice Address - Phone:541-676-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health