Provider Demographics
NPI:1700911989
Name:ORTIZ, DIANA (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 E AMANDA CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2402
Mailing Address - Country:US
Mailing Address - Phone:714-485-2642
Mailing Address - Fax:
Practice Address - Street 1:7821 E AMANDA CIR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2402
Practice Address - Country:US
Practice Address - Phone:714-485-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20207104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker