Provider Demographics
NPI:1790864239
Name:ORTIZ, BERTA ELISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERTA
Middle Name:ELISA
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:PO BOX 2975
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-2975
Mailing Address - Country:US
Mailing Address - Phone:323-969-0951
Mailing Address - Fax:323-874-2022
Practice Address - Street 1:4221 WILSHIRE BLVD
Practice Address - Street 2:SUITE 290 7-A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3512
Practice Address - Country:US
Practice Address - Phone:323-969-0951
Practice Address - Fax:323-874-2022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9877103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist