Provider Demographics
NPI:1013440379
Name:ORTIZ, LUIS ARMANDO JR (CADC II A060761221)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ARMANDO
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:CADC II A060761221
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4190 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3435
Mailing Address - Country:US
Mailing Address - Phone:951-588-3669
Mailing Address - Fax:
Practice Address - Street 1:2085 RUSTIN AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2498
Practice Address - Country:US
Practice Address - Phone:951-955-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 225C00000X
CAA060761221171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor