Provider Demographics
NPI:1942592621
Name:EDWYN W ORTIZ-NANCE
Entity Type:Organization
Organization Name:EDWYN W ORTIZ-NANCE
Other - Org Name:E.W. ORTIZ-NANCE, PSYD PSYCHOLOGICAL SERVICES AT THE CENTRE FOR HARMO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ORTIZ-NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:559-252-6353
Mailing Address - Street 1:2060 N WINERY AVE
Mailing Address - Street 2:102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4816
Mailing Address - Country:US
Mailing Address - Phone:559-252-6353
Mailing Address - Fax:559-252-7964
Practice Address - Street 1:2060 N WINERY AVE
Practice Address - Street 2:#102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-4816
Practice Address - Country:US
Practice Address - Phone:559-252-6353
Practice Address - Fax:559-252-7964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467625368OtherSYNCHRONY OF VISALIA, INC.