Healthcare Provider Details

I. General information

NPI: 1033031018
Provider Name (Legal Business Name): ISRAEL ALBINO ORTIZ DNP PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6552 S DAYS END CT
WEST VALLEY CITY UT
84081-5709
US

IV. Provider business mailing address

6552 S DAYS END CT
WEST VALLEY CITY UT
84081-5709
US

V. Phone/Fax

Practice location:
  • Phone: 801-574-6109
  • Fax:
Mailing address:
  • Phone: 801-574-6109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11224541-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: