Healthcare Provider Details

I. General information

NPI: 1679094825
Provider Name (Legal Business Name): RUBEN ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E THOMPSON BLVD
VENTURA CA
93001-3008
US

IV. Provider business mailing address

955 E THOMPSON BLVD
VENTURA CA
93001-3008
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-9100
  • Fax: 805-641-9040
Mailing address:
  • Phone: 805-641-9100
  • Fax: 818-641-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: