Healthcare Provider Details

I. General information

NPI: 1538616651
Provider Name (Legal Business Name): JENNIFER ALEXIS ORTIZ PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: J. ALEXIS ORTIZ PH.D.

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 4TH ST # 404
SAN FRANCISCO CA
94158-2249
US

IV. Provider business mailing address

1225 4TH ST # 404
SAN FRANCISCO CA
94158-2249
US

V. Phone/Fax

Practice location:
  • Phone: 415-335-6840
  • Fax:
Mailing address:
  • Phone: 415-335-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: