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General NPI Number Information
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NPI Number | 1629953476
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Entity Type | Individual
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Provider Name | JUSTIN BARONIA ORTIZ ATC
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Gender | Male
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 1779 WOODSIDE RD STE 102
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City | REDWOOD CITY
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State | CA
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Zip | 94061-3461
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Country | US
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Telephone | 650-780-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 4812 STEPPE CT
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City | ELK GROVE
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State | CA
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Zip | 95757-1665
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000029307
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License Number State | CA
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