Healthcare Provider Details

I. General information

NPI: 1073431409
Provider Name (Legal Business Name): TIARA ORTIZ AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26726 CROWN VALLEY PKWY STE 210
MISSION VIEJO CA
92691-8006
US

IV. Provider business mailing address

26726 CROWN VALLEY PKWY STE 210
MISSION VIEJO CA
92691-8006
US

V. Phone/Fax

Practice location:
  • Phone: 949-276-4008
  • Fax: 949-364-7124
Mailing address:
  • Phone: 949-276-4008
  • Fax: 949-364-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number4180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: