Provider Demographics
NPI:1629238894
Name:ORTIZ-NANCE, IAN JAVIER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:JAVIER
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 1:4043 E KERCKHOFF AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-2921
Mailing Address - Country:US
Mailing Address - Phone:559-313-7264
Mailing Address - Fax:559-456-8446
Practice Address - Street 1:1041 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4119
Practice Address - Country:US
Practice Address - Phone:559-635-4252
Practice Address - Fax:559-635-4281
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist