Provider Demographics
NPI:1467625368
Name:ORTIZ-NANCE, EDWYN W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWYN
Middle Name:W
Last Name:ORTIZ-NANCE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 N. DEMAREE ST.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7896
Mailing Address - Country:US
Mailing Address - Phone:559-635-4252
Mailing Address - Fax:559-635-4281
Practice Address - Street 1:1041 N. DEMAREE ST.
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7896
Practice Address - Country:US
Practice Address - Phone:559-635-4252
Practice Address - Fax:559-635-4281
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18170103G00000X, 103TC2200X, 103TM1800X, 103TF0000X, 103TC0700X
WAPY60221926103G00000X, 101Y00000X, 103TC0700X
WAPS60221926103TC2200X, 103TM1800X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor