Provider Demographics
NPI:1538303094
Name:ORTIZ, HENRY JAMES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JAMES
Last Name:ORTIZ
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 1:289 DOCKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-7400
Mailing Address - Country:US
Mailing Address - Phone:310-776-2667
Mailing Address - Fax:310-929-7811
Practice Address - Street 1:289 DOCKSIDE LN
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-7400
Practice Address - Country:US
Practice Address - Phone:310-776-2667
Practice Address - Fax:310-929-7811
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19605103TC0700X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily