Provider Demographics
NPI:1922323575
Name:ORTIZ, DARIANA (LMFT 102421)
Entity Type:Individual
Prefix:
First Name:DARIANA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMFT 102421
Other - Prefix:
Other - First Name:DARIANA
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT 102421
Mailing Address - Street 1:1275 W. PARK AVE, #7461
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-557-6574
Mailing Address - Fax:909-363-9202
Practice Address - Street 1:2068 ORANGE TREE LN STE 216
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374
Practice Address - Country:US
Practice Address - Phone:909-557-6574
Practice Address - Fax:909-363-9202
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT-102421106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist