Healthcare Provider Details

I. General information

NPI: 1891364618
Provider Name (Legal Business Name): JASON FRED ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W COLUMBUS ST
BAKERSFIELD CA
93301-1263
US

IV. Provider business mailing address

PO BOX 3218
BAKERSFIELD CA
93385-3218
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-0245
  • Fax:
Mailing address:
  • Phone: 661-325-8510
  • Fax: 661-325-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA055230324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: