Provider Demographics
NPI:1649543927
Name:ORTIZ, MARIA ALICIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ALICIA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-2433
Mailing Address - Country:US
Mailing Address - Phone:661-765-7025
Mailing Address - Fax:661-765-7045
Practice Address - Street 1:1021 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2433
Practice Address - Country:US
Practice Address - Phone:661-765-7025
Practice Address - Fax:661-765-7045
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA32071167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician