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General NPI Number Information
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NPI Number | 1275651895
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Entity Type | Individual
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Provider Name | CHARLYN ORTAL ACSW
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 1207 E FRUIT ST
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City | SANTA ANA
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State | CA
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Zip | 92701-4296
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Country | US
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Telephone | 626-577-2261
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Fax | 626-577-2543
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Provider Business Mailing Address
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Address Line | 12181 PEACOCK CT APT 8
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City | GARDEN GROVE
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State | CA
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Zip | 92841-3761
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Country | US
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Telephone | 626-374-3206
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 111122
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License Number State | CA
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