Healthcare Provider Details

I. General information

NPI: 1780336685
Provider Name (Legal Business Name): CECILE LEONA ORTIZ CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 PINE FOREST BLVD NE STE 1
GRAND RAPIDS MI
49525-2157
US

IV. Provider business mailing address

110 W HILLSDALE ST APT 544
LANSING MI
48933-2340
US

V. Phone/Fax

Practice location:
  • Phone: 808-291-6414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7601000168
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: