Healthcare Provider Details

I. General information

NPI: 1851228282
Provider Name (Legal Business Name): GLADYS ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 CHAMBERS RD STE 219
TUSTIN CA
92780-6936
US

IV. Provider business mailing address

2522 CHAMBERS RD STE 219
TUSTIN CA
92780-6936
US

V. Phone/Fax

Practice location:
  • Phone: 714-552-4725
  • Fax: 949-264-9490
Mailing address:
  • Phone: 714-552-4725
  • Fax: 949-264-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: