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NPI Code Detail

MEDICARE: ALEXIS M ORTIZ

MEDICARE: ALEXIS M 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
1103T00000XPsychologist

General Provider Information

NPI Number : 1770116063
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS M ORTIZ
Provider Business Mailing Address
First Line : 5 REVERE DR STE 120
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-8005
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1941 EAST RD STE 2100
Second Line :
City : HOUSTON
State : TX
Zip : 77054-6010
Country : US
Telephone Number : 713-486-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2020
Last Update Date : 03/06/2026

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Directions to “ ALEXIS M ORTIZ ” Practice Location

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