Provider Demographics
NPI:1831545607
Name:ORTIZ, CHRISTINA MARLE (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARLE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 WESTWOOD BLVD # 937
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2109
Mailing Address - Country:US
Mailing Address - Phone:424-278-4455
Mailing Address - Fax:
Practice Address - Street 1:2355 WESTWOOD BLVD #937
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2109
Practice Address - Country:US
Practice Address - Phone:424-278-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32597103T00000X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist