Healthcare Provider Details

I. General information

NPI: 1548943806
Provider Name (Legal Business Name): ANDREA B. ORTIZ-RINCON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA ORTIZ

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N PASEO DE ONATE
ESPANOLA NM
87532-2687
US

IV. Provider business mailing address

1422 PASEO DE PERALTA
SANTA FE NM
87501-4391
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-0081
  • Fax:
Mailing address:
  • Phone: 505-820-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2023-0819
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: