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General NPI Number Information
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NPI Number | 1033747712
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Entity Type | Individual
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Provider Name | MR. SERGIO IGNACIO ORTIZ JR.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 2922 ROSEDALE ST
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City | HOUSTON
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State | TX
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Zip | 77004-6188
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Country | US
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Telephone | 713-874-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 9702 N SAM HOUSTON PKWY E APT 1133
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City | HUMBLE
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State | TX
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Zip | 77396-4550
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Country | US
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Telephone | 214-254-8245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | TX
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