Healthcare Provider Details

I. General information

NPI: 1376106740
Provider Name (Legal Business Name): MORGAN E ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

IV. Provider business mailing address

4913 PIEDRA ROSA ST NE
ALBUQUERQUE NM
87111-2119
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-5278
  • Fax:
Mailing address:
  • Phone: 505-717-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0203671
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: