Healthcare Provider Details

I. General information

NPI: 1023928355
Provider Name (Legal Business Name): OLIVIA JACQUELINE ORTIZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25864 BUSINESS CENTER DR STE C
REDLANDS CA
92374-4515
US

IV. Provider business mailing address

25864 BUSINESS CENTER DR STE C
REDLANDS CA
92374-4515
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-7700
  • Fax:
Mailing address:
  • Phone: 909-796-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT310646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: