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General NPI Number Information
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NPI Number | 1306980982
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Entity Type | Individual
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Provider Name | JOSEPH RALPH ORTIZ I PHD, MFT
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 1573 GOLD CUP CT
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City | REDLANDS
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State | CA
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Zip | 92374-2767
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Country | US
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Telephone | 909-838-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 1573 GOLD CUP CT
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City | REDLANDS
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State | CA
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Zip | 92374-2767
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Country | US
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Telephone | 909-794-0973
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 24073
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 25127
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License Number State | CA
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