Provider Demographics
NPI:1881193332
Name:ORTIZ, ELIZABETH RENE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RENE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3343
Mailing Address - Country:US
Mailing Address - Phone:925-596-7000
Mailing Address - Fax:
Practice Address - Street 1:5111 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3343
Practice Address - Country:US
Practice Address - Phone:925-596-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician