Provider Demographics
NPI:1750770533
Name:ORTIZ, RENEE (LMS)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 RIMPAU AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5723
Mailing Address - Country:US
Mailing Address - Phone:951-582-9627
Mailing Address - Fax:951-582-0345
Practice Address - Street 1:710 RIMPAU AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5723
Practice Address - Country:US
Practice Address - Phone:951-582-9627
Practice Address - Fax:951-582-0345
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59215225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist