Provider Demographics
NPI:1255858908
Name:ORTANEZ, GIAN-CARLO NINO RESABAL
Entity Type:Individual
Prefix:
First Name:GIAN-CARLO NINO
Middle Name:RESABAL
Last Name:ORTANEZ
Suffix:
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 1:25529 BUENA FORTUNA LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-2043
Mailing Address - Country:US
Mailing Address - Phone:951-552-5449
Mailing Address - Fax:
Practice Address - Street 1:1656 MENDOCINO WAY
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3732
Practice Address - Country:US
Practice Address - Phone:951-552-5449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst