Provider Demographics
NPI:1245797521
Name:ORTEZ, RAMONA (SUDCC 15932)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:ORTEZ
Suffix:
Gender:F
Credentials:SUDCC 15932
Other - Prefix:
Other - First Name:RAMONA
Other - Middle Name:
Other - Last Name:ORTEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDCC 19532
Mailing Address - Street 1:33993 L ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-6238
Mailing Address - Country:US
Mailing Address - Phone:909-905-4828
Mailing Address - Fax:
Practice Address - Street 1:13333 PALMDALE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9364
Practice Address - Country:US
Practice Address - Phone:760-487-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15932101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)