Healthcare Provider Details

I. General information

NPI: 1386530095
Provider Name (Legal Business Name): HECTOR ABELARDO ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18107 CALAVERAS DR
LATHROP CA
95330-8417
US

IV. Provider business mailing address

510 WHISPERING WIND DR STE 110
TRACY CA
95377-8119
US

V. Phone/Fax

Practice location:
  • Phone: 209-420-4170
  • Fax:
Mailing address:
  • Phone: 209-832-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: