MEDICARE: YALY MANDOZA ORTIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		MN

General Provider Information

NPI Number	:	1326978263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YALY MANDOZA ORTIZ

Provider Business Mailing Address
First Line	:	6045 LYNDALE AVE S APT 109
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-2236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6045 LYNDALE AVE S APT 109
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-2236
Country	:	US
Telephone Number	:	612-860-9962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “ YALY MANDOZA ORTIZ ” Practice Location

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