Healthcare Provider Details

I. General information

NPI: 1982732624
Provider Name (Legal Business Name): HIPOLITO RODERIC ORTIZ LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 7TH ST
MADERA CA
93638-3780
US

IV. Provider business mailing address

PO BOX 1064
HANFORD CA
93232-1064
US

V. Phone/Fax

Practice location:
  • Phone: 559-395-0451
  • Fax:
Mailing address:
  • Phone: 559-903-8354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48183
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: