Provider Demographics
NPI:1336997345
Name:ORTIZ, STEPHANIE RENELLE (RAD-T)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENELLE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RAD-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 STOCKDALE HWY STE 275
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2667
Mailing Address - Country:US
Mailing Address - Phone:661-900-4488
Mailing Address - Fax:
Practice Address - Street 1:5121 STOCKDALE HWY STE 275
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2667
Practice Address - Country:US
Practice Address - Phone:661-868-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker