Provider Demographics
NPI:1942844311
Name:HENRY J ORTIZ PSYD INC
Entity Type:Organization
Organization Name:HENRY J ORTIZ PSYD INC
Other - Org Name:HENRY ORTIZ PSYD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-776-2667
Mailing Address - Street 1:289 DOCKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-7400
Mailing Address - Country:US
Mailing Address - Phone:310-776-2667
Mailing Address - Fax:
Practice Address - Street 1:289 DOCKSIDE LN
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-7400
Practice Address - Country:US
Practice Address - Phone:310-776-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty