Healthcare Provider Details

I. General information

NPI: 1942560057
Provider Name (Legal Business Name): ENRIQUE ORTIZ ACSW, PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S POPLAR ST
SANTA ANA CA
92704-4321
US

IV. Provider business mailing address

1801 S POPLAR ST
SANTA ANA CA
92704-4321
US

V. Phone/Fax

Practice location:
  • Phone: 714-433-3481
  • Fax:
Mailing address:
  • Phone: 714-433-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number96344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: