Provider Demographics
NPI:1255567699
Name:ORTIZ, GERMAN ERNESTO I (LMFT)
Entity type:Individual
Prefix:
First Name:GERMAN
Middle Name:ERNESTO
Last Name:ORTIZ
Suffix:I
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13730 BRANFORD ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6221
Mailing Address - Country:US
Mailing Address - Phone:626-808-4176
Mailing Address - Fax:
Practice Address - Street 1:680 E COLORADO BLVD STE 180
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-6144
Practice Address - Country:US
Practice Address - Phone:626-808-4176
Practice Address - Fax:661-524-9950
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT110663106H00000X
225400000X
CA130408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92-2633765OtherMEDICAL