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General NPI Number Information
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NPI Number | 1265768899
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Entity Type | Individual
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Provider Name | KYLIE OLIVIA PEDERSEN-ORTIZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 300 HILLMONT STREET BLDG. 340, STE. 302
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City | VENTURA
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State | CA
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Zip | 93003
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Country | US
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Telephone | 805-652-6608
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Fax | 805-652-6136
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Provider Business Mailing Address
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Address Line | 1040 FLYNN RD
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City | CAMARILLO
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State | CA
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Zip | 93012-5092
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Country | US
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Telephone | 805-673-3930
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Fax | 805-659-3217
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW74365
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License Number State | CA
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