Provider Demographics
NPI:1659155653
Name:ORTIZ, JUSTIN LUIS
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LUIS
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2719
Mailing Address - Country:US
Mailing Address - Phone:408-757-8178
Mailing Address - Fax:
Practice Address - Street 1:950 W JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2719
Practice Address - Country:US
Practice Address - Phone:408-757-8178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker