Healthcare Provider Details

I. General information

NPI: 1659155927
Provider Name (Legal Business Name): DANIEL JAVIER ORTA AMFT #140397
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 POLLASKY AVE STE D
CLOVIS CA
93612-1159
US

IV. Provider business mailing address

106 POLLASKY AVE STE D
CLOVIS CA
93612-1159
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-3775
  • Fax:
Mailing address:
  • Phone: 559-203-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: