Healthcare Provider Details

I. General information

NPI: 1043873219
Provider Name (Legal Business Name): CYNTHIA GUADALUPE ORTIZ-RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 17TH ST
SANTA ANA CA
92706-3506
US

IV. Provider business mailing address

7120 HAYVENHURST AVE STE 322
VAN NUYS CA
91406-3813
US

V. Phone/Fax

Practice location:
  • Phone: 800-930-5773
  • Fax:
Mailing address:
  • Phone: 800-930-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: