Healthcare Provider Details

I. General information

NPI: 1124974662
Provider Name (Legal Business Name): DELANEY ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 AVALON BLVD APT 124
CARSON CA
90745-2265
US

IV. Provider business mailing address

21601 AVALON BLVD APT 124
CARSON CA
90745-2265
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-4080
  • Fax: 657-276-4740
Mailing address:
  • Phone: 657-241-4080
  • Fax: 657-276-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86417774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: