Healthcare Provider Details

I. General information

NPI: 1659793735
Provider Name (Legal Business Name): LORENA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 F ST
WASCO CA
93280-2040
US

IV. Provider business mailing address

6314 SYMPHONY ST
BAKERSFIELD CA
93307-7018
US

V. Phone/Fax

Practice location:
  • Phone: 661-674-3377
  • Fax: 661-240-5840
Mailing address:
  • Phone: 661-205-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT109115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: