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General NPI Number Information
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NPI Number | 1083226526
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Entity Type | Individual
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Provider Name | YULISSA ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 1160 S GRAND AVE
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City | GLENDORA
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State | CA
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Zip | 91740-5000
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Country | US
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Telephone | 626-335-5980
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1191
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City | PAUMA VALLEY
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State | CA
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Zip | 92061-1191
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Country | US
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Telephone | 760-532-9690
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APCC12214
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License Number State | CA
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