Healthcare Provider Details

I. General information

NPI: 1285118208
Provider Name (Legal Business Name): FABIAN ORTIZ-RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 PARKMOOR AVE
SAN JOSE CA
95128-2407
US

IV. Provider business mailing address

PO BOX 127
NAPA CA
94559-0127
US

V. Phone/Fax

Practice location:
  • Phone: 408-288-0450
  • Fax: 408-282-0400
Mailing address:
  • Phone: 707-255-3300
  • Fax: 408-282-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: