Healthcare Provider Details

I. General information

NPI: 1407679269
Provider Name (Legal Business Name): HEATHER MARY ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 RIDDER PARK DRIVE
SAN JOSE CA
95131
US

IV. Provider business mailing address

9015 MURRAY AVE STE 100
GILROY CA
95020-3675
US

V. Phone/Fax

Practice location:
  • Phone: 408-225-9291
  • Fax:
Mailing address:
  • Phone: 408-842-7138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: