Provider Demographics
NPI:1558883827
Name:ORTIZ, MORIAH TONANTZIN (RN)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:TONANTZIN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MORIAH
Other - Middle Name:TONANTZIN
Other - Last Name:HERBERT ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:391 BRIDGEVIEW DR APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2256
Mailing Address - Country:US
Mailing Address - Phone:415-317-0772
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 194247
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94119-4247
Practice Address - Country:US
Practice Address - Phone:415-547-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2017-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA822362163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management