Healthcare Provider Details

I. General information

NPI: 1952100935
Provider Name (Legal Business Name): TINA MARIE ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 04/08/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 JULIAN AVE
SAN FRANCISCO CA
94103-3507
US

IV. Provider business mailing address

56 JULIAN AVE
SAN FRANCISCO CA
94103-3507
US

V. Phone/Fax

Practice location:
  • Phone: 415-575-4031
  • Fax: 415-366-7083
Mailing address:
  • Phone: 415-865-0964
  • Fax: 415-366-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: