Provider Demographics
NPI:1780712075
Name:ORTIZ, PASCUAL JOSE (BS)
Entity type:Individual
Prefix:
First Name:PASCUAL
Middle Name:JOSE
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 N SONORA AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3965
Mailing Address - Country:US
Mailing Address - Phone:559-276-7558
Mailing Address - Fax:
Practice Address - Street 1:4705 N SONORA AVE STE 113
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3965
Practice Address - Country:US
Practice Address - Phone:559-276-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV8063705OtherDMV DL
CA1669559878OtherMEDICAL