Provider Demographics
NPI:1912771916
Name:ORTIZ INIGUEZ, ISMAEL
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:ORTIZ INIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66269 AVENIDA LADERA
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1734
Mailing Address - Country:US
Mailing Address - Phone:760-851-8321
Mailing Address - Fax:
Practice Address - Street 1:66269 AVENIDA LADERA
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-1734
Practice Address - Country:US
Practice Address - Phone:760-851-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1188291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical