Provider Demographics
NPI:1912488248
Name:ORTIZ, JOSE LUIS (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3516
Mailing Address - Country:US
Mailing Address - Phone:361-834-7372
Mailing Address - Fax:
Practice Address - Street 1:225 E WARD ST
Practice Address - Street 2:
Practice Address - City:GOLIAD
Practice Address - State:TX
Practice Address - Zip Code:77963-4006
Practice Address - Country:US
Practice Address - Phone:361-645-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist