Healthcare Provider Details

I. General information

NPI: 1316832710
Provider Name (Legal Business Name): MS. AMBER LANAE LOUISE ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 5TH AVE STE 320
YOUNGSTOWN OH
44504-1765
US

IV. Provider business mailing address

1350 5TH AVE STE 320
YOUNGSTOWN OH
44504-1765
US

V. Phone/Fax

Practice location:
  • Phone: 330-572-0175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number510124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: