Healthcare Provider Details

I. General information

NPI: 1902076110
Provider Name (Legal Business Name): MRS. LUCILA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 TULARE ST STE 200
FRESNO CA
93721-2281
US

IV. Provider business mailing address

1837 HOWARD RD BLDG MADERA
MADERA CA
93637-5122
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-4800
  • Fax:
Mailing address:
  • Phone: 559-416-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8710
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: