Healthcare Provider Details

I. General information

NPI: 1104632579
Provider Name (Legal Business Name): GRACE ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 GARDENSIDE CT
SACRAMENTO CA
95829-9282
US

IV. Provider business mailing address

8202 GARDENSIDE CT
SACRAMENTO CA
95829-9282
US

V. Phone/Fax

Practice location:
  • Phone: 916-544-1386
  • Fax:
Mailing address:
  • Phone: 916-544-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number771933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: