Provider Demographics
NPI:1891485355
Name:ORTIZ, BERNADETTE VALLES
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:VALLES
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 1:2707 TRANSWORLD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-3948
Mailing Address - Country:US
Mailing Address - Phone:209-468-4847
Mailing Address - Fax:
Practice Address - Street 1:2707 TRANSWORLD DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-3948
Practice Address - Country:US
Practice Address - Phone:209-468-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool