MEDICARE: CHRISTIANNA ASHLEY ORTIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1023482098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANNA ASHLEY ORTIZ

Provider Business Mailing Address
First Line	:	4261 HOME STRETCH DR
Second Line	:
City	:	PARKTON
State	:	NC
Zip	:	28371-8799
Country	:	US
Telephone Number	:	424-207-4521
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 APPLE ST STE 221
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-2670
Country	:	US
Telephone Number	:	857-829-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	12/07/2022

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Directions to “ CHRISTIANNA ASHLEY ORTIZ ” Practice Location

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