Provider Demographics
NPI:1891364618
Name:ORTIZ, JASON FRED
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:FRED
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:PO BOX 3218
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385-3218
Mailing Address - Country:US
Mailing Address - Phone:661-325-8510
Mailing Address - Fax:661-325-3929
Practice Address - Street 1:531 KNOTTS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3043
Practice Address - Country:US
Practice Address - Phone:661-325-8510
Practice Address - Fax:661-325-3929
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1434590621101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)