Provider Demographics
NPI:1316360001
Name:ORTIZ ALCANTARA, LILIA ARACELI
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:ARACELI
Last Name:ORTIZ ALCANTARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3381 GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2006
Mailing Address - Country:US
Mailing Address - Phone:805-217-6019
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR # 150
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2612
Practice Address - Country:US
Practice Address - Phone:805-981-8460
Practice Address - Fax:805-981-8461
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT110570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist