Healthcare Provider Details

I. General information

NPI: 1710565866
Provider Name (Legal Business Name): ALFONSO ORTIZ CRUZ MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

401 PARNASSUS AVE
SAN FRANCISCO CA
94143-2211
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7000
  • Fax: 415-476-7320
Mailing address:
  • Phone: 415-476-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA199661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: