Doctor Name: | MR. RAYMOND C ORTIZ |
NPI Number: | 1013384387 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MFTI |
License Number: | |
Business Practice Address: | 126 W 25th Ave Ste 202 San Mateo, CA - 944032208 |
Business Phone Number: | 6502862090 |
Business Fax Number: | |
Mailing Address: | 126 W 25th Ave Ste 202, SAN MATEO |
State: | CA |
Postal Code: | 944032208 |
Phone Number: | 6502862090 |
Fax Number: | |
NPI Enumeration Date: | 08/21/2015 |
NPI Last Update Date: | 03/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |