Healthcare Provider Details

I. General information

NPI: 1134541634
Provider Name (Legal Business Name): YOSELIN ELIZABETH ORTIZ-LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/24/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CA-104
IONE CA
95640
US

IV. Provider business mailing address

4001 CA-104
IONE CA
95640
US

V. Phone/Fax

Practice location:
  • Phone: 209-274-4911
  • Fax:
Mailing address:
  • Phone: 209-274-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: