Provider Demographics
NPI:1407493943
Name:ORTIZ, KEILA RENEE K
Entity Type:Individual
Prefix:
First Name:KEILA RENEE
Middle Name:K
Last Name:ORTIZ
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 1:2042 COYNE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1333
Mailing Address - Country:US
Mailing Address - Phone:808-384-8727
Mailing Address - Fax:
Practice Address - Street 1:2042 COYNE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1333
Practice Address - Country:US
Practice Address - Phone:808-384-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician