Provider Demographics
NPI:1659438299
Name:ORTIZ, SILVIA MARIA (PHD)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:MARIA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2802
Mailing Address - Country:US
Mailing Address - Phone:805-541-5280
Mailing Address - Fax:805-541-5280
Practice Address - Street 1:694 SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2802
Practice Address - Country:US
Practice Address - Phone:805-541-5280
Practice Address - Fax:805-541-5280
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11656103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling