Provider Demographics
NPI:1447565452
Name:CHIN-ORTIZ, SHI-MING PEGGY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHI-MING
Middle Name:PEGGY
Last Name:CHIN-ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WESTLAKE CTR
Mailing Address - Street 2:#425
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1430
Mailing Address - Country:US
Mailing Address - Phone:415-869-2895
Mailing Address - Fax:
Practice Address - Street 1:842 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-2315
Practice Address - Country:US
Practice Address - Phone:415-869-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical