Basic Information
| Provider Information | |||||||||
| NPI: | 1780712075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | PASCUAL | ||||||||
| MiddleName: | JOSE | ||||||||
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| Credential: | B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4705 N SONORA AVE STE 113 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937223965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592767558 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4705 N SONORA AVE STE 113 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937223965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592767558 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171R00000X | N | Other Service Providers | Interpreter |
ID Information
| ID | Type | State | Issuer | Description | V8063705 | 01 | CA | DMV DL | OTHER | 1669559878 | 01 | CA | MEDICAL | OTHER |