Provider Demographics
NPI:1851047658
Name:ORTIZ-COBIAN, KATHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:ORTIZ-COBIAN
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 1:125 S MAIN ST # 199
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4258
Mailing Address - Country:US
Mailing Address - Phone:424-345-4525
Mailing Address - Fax:
Practice Address - Street 1:125 S MAIN ST # 199
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4258
Practice Address - Country:US
Practice Address - Phone:424-345-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program