Healthcare Provider Details

I. General information

NPI: 1124934179
Provider Name (Legal Business Name): SARA NATALIA ORTIZ-CUBIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E CERRITOS AVE
GLENDALE CA
91205-3107
US

IV. Provider business mailing address

522 W STOCKER ST APT 4
GLENDALE CA
91202-2299
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-7207
  • Fax:
Mailing address:
  • Phone: 818-640-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220112188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: